What increases ADH Secretion?
osmoreceptors in hypothalamus respond to changes in serum osmolality
What is diabetes insipidus?
NOT ENOUGH ADH
DI - kidney's cannot reabsorb water, cannot concentrate urine, and they have concentrated blood. T/F?
What are the 3 types of DI?
central (not enough ADH) and nephrogenic (lack of renal response to adh), dipsogenic (oral intake of large amounts of water suppresses release of ADH)
Central DI - what causes it?
head injury, neurosurgery, tumor, hypoxic injuries, infection (meningitis, encephalitis), congenital CNS defects
What causes nephrogenic DI?
drug toxicity (amphotericin, gentamicin, lasix), electrolyte disturbances, sickle cell disease, renal disease
Dipsogenic - more than likely psych T/F?
Dipsogenic - might also be because we fead an infant what?
Water. do not do that until they're about 6 months old / can hold a sippy cup.
What are some manifestations of DI?
dehydration, increased plasma osmolality >295, hypernatremia, decreased urine osmolality, decreased urine Na5ml/kg/hr, SG
What is hypernatremia and what does it indicate?
serum sodium greater than 145, indicates dehydration
What are some signs of dehydration?
Dry mucus membranes, irritability, lethargy, headache, seizures
How do we manage central DI?
Rapid volume expansion with isotonic fluids if in shock, slowly decrease Na by 1-2 mew/hr over 24 hours, hypotonic fluid replacement, DDAVP (spray in nose), vasopressin, NS/LR
What are the goals of UO and SG in managing central DI?
UO = 1.010
what is SIADH?
Syndrome of inappropriate antidiuretic hormone secretion - aka, TOO MUCH ADH
SIADH - excessive reabsorption of water, hypervolemia, hyponatremia, etc. T/F?
What are some causes of SIADH?
Pulmonary conditions (infection, asthma, pneumothorax, positive pressure ventilation --- increased pressure), CNS conditions (infections, trauma and hypoxic injuries, hydrocephalus, vascular abnormalities), medications (vasopessin, antidepressants antianxiety, antipsychotic, seizure meds, DDAVP, narcotics, chemo, barbituates), post-operative patients
SIADH - may have increased vasopressin for 3-4 days post-op. T/F?
What are some manifestations of SIADH?
Decreased urine output 20, low serum osmolality
What are some manifestations of hyponatremia?
headache, nausea/vomiting, confusion, seizures, muscle twitching, cerebral edema
How do we treat SIADH?
eliminate excess water, increase serum osmolality, fluid restriction (30-75% of maintenance!!), hypertonic saline for SEVERE cases, loop diuretics
For treating SIADH, what's the initial goal for severe cases?
Initial goal 125-230 then Na should rise by 0.5 meq/l every hour - - risk of cerebral demyelination.
Fill in the info!
How many children in the US have DM Type 1 + 2?
216,000, with AA's and Hispanics at greater risk.
When's the typical age of onset for Type 1? (Hint, 2 sets!)
Type 1 Dm - info?
Insulin-producing cells in the pancreas are destroyed, cells starve to death so glucose in unable to enter the cell and remains in the bloodstream.
Dm Type 1 tends to affect males more than females - T/F?
How do we diagnose DM Type 1?
may mimic severe case of flu, ketosis, weight loss, vomiting, polydipsia, polyuria, polyphagia, malaise, coma, random plasma glucose >126, 2 hr pplasma glucose >200 during an OGTT
how do we manage Type 1?
insulin therapy, glucose monitoring (goal range 80-120), lab measurement of AIC, urine testing for ketones
do we always test for ketones?
No - tested every 3 hours during illness and whenever glucose is >240 when illness not present.
Hypoglycemia - symptoms?
Cold and clammy, needs some candy! Hunger, shakiness, weakness, paleness, blurry vision, sleepiness, sweating, anxiety, dilated pupils, dazed appearance, restlessness, seizures, etc.