Term
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Definition
| High levels of antidiuretic hormone (ADH) in absence of normal physiologic stimuli for its release |
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Term
| What are the causes of SIADH? |
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Definition
Ectopically produced ADH (Adenocarcinomas) - primary reason ppl develop SIADH, from carcinoma is the lungs.
Transient SIADH - Post pituitary surgery |
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Term
| What does the severity of SIADH clinical manifestations depend on? |
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Definition
| severity and rate of onset of hyponatremia |
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Term
| What are the symptoms of hyponatremia? |
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Definition
Sx of Hyponatremia
Thirst, Dyspnea, Fatigue
Neurologic
Dulled sensorium, confusion, lethargy
Muscle twitching, convulsions
GI:
Impaired taste, anorexia, vomiting, cramps
Severe Sx @ Na+ < 100-115 mEq/L
Possible irreversible neurologic damage |
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Term
| What is the pharmacotherapy for SIADH? |
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Definition
Drug Prototype
Demeclocycline (Declomycin)
Classification
Tetracycline broad-spectrum antibiotic
Drug use
Antibiotic therapy
Treatment of persistent SIADH
MOA
Interferes w/ renal response to ADH. |
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Term
| What is the Nursing Care for SIADH? |
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Definition
Immediate goal:
- Restore normal fluid volume & osmolality
Mild symptoms & mild hyponatremia (< 125)
- Fluid restrictions only (1000 ml/day)
Severe symptoms &/or severe hyponatremia (<120)
- 3-5% NS IV (have to give s-l-o-w-l-y; over hours to days)
- 500 ml/day fluid restriction
Drug therapy only in chronic
- Sometimes diuretics
- Sometimes democlocycline/lithium (block effects of ADH) |
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Term
| What is Diabetes Insipidus? |
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Definition
Inability to concentrate urine due to insufficiency of ADH
Two Forms: Neurogenic (central) and Nephrogenic (renal) |
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Term
| What is Neurogenic (Central) Diabetes Insipidous? |
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Definition
Neurogenic (central)
Causes
- Hypothalamus or pituitary gland damage
Associated disorders
- Stroke, traumatic brain injury
- Cerebral infections
Onset: Rapid often permanent |
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Term
| What is Nephrogenic (Renal) Diabetes Insipidous? |
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Definition
Causes
- Loss of kidney function
- Drugs (e.g., Lithium)
Associated disorders
- Chronic kidney disease
Onset: Less abrupt onset |
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Term
| What are the clinical manifestations of Diabetes Insipidus? |
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Definition
Polyuria & Polydipsia!
Urine:
- Low specific gravity and osmolality
Serum:
- Osmolality?? concentrated in blood
- Dehydration
Others based on severity
- Electrolyte imbalances
- Hypovolemic shock -> death |
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Term
| What is the drug for Neurogenic DI? |
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Definition
Desmopressin. M.O.A.: Synthetic ADH
Replacement therapy |
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Term
| What is the drug for Nephrogenic DI? |
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Definition
Hydrochlorothiazide (HCTZ). Decreases polyuria
Increases osmolality. |
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Term
| What is Addison's Disease? |
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Definition
| “Primary” adrenocortical insufficiency , Decreased secretion of Cortisol (hydrocortisone), Aldosterone, and Androgens |
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Term
| What are early clinical manifestations of Addison Disease? |
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Definition
Early
Anorexia, weight loss
Weakness, malaise, apathy
Electrolyte imbalances
Skin hyperpigmentation |
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Term
| What are other clinical manifestations of Addison Disease? Hypoaldosteronism? |
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Definition
Hypoaldosteronism (think Na & water retention problems!)
Hypotension
- ↓ Vascular tone
- ↓ CO
- ↓ Circulating blood volume
Salt craving
- ↓ Serum Na levels
- Dehydration |
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Term
| What are other clinical manifestations of Addison Disease? Hypocortisolism? |
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Definition
Hypocortisolism (think lack of stress hormones – No energy!!)
- Hypoglycemia
- Weakness & fatigue
Unsuppressed ACTH production
- Hyperpigmentation |
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Term
| What is Pheochromocytoma? |
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Definition
| Tumor of chromaffin tissue that results in the excessive production and release of catecholamines |
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Term
| What are the clinical manifestations of Pheochromocytoma? |
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Definition
Spells of severe HTN w/
- Headache
- Tachycardia/Palpitations
- Diaphoresis
Other: Hyperglycemia |
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