Diabetes insipidus

Subject: Medical and Surgical Nursing I (Theory)

Overview

A deficiency in insulin production, insulin action, or both characterize the metabolic disease class known as diabetes mellitus. Type 1 (insulin-dependent), Type 2 (non-insulin-dependent), Type 1 (in children), and Type 2 (adults) are the four subtypes. Some women develop gestational diabetes, etc. Inadequate insulin, a breakdown in insulin synthesis, drug-induced (such as by intravenous pentamidine), etc., are all potential triggers. Increased urination, blurred vision, and heightened thirst are just a few of its symptoms. It is common practice to check a variety of blood parameters, such as fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycosylated, hemoglobin, cholesterol, triglyceride levels, blood urea nitrogen, and serum creatine. Insulin, both short and long-acting, can be used to treat the disease. The nurse has to provide the insulin type, dosage, and species.

A failure to save water and electrolytes due to a lack of antidiuretic hormone (ADH, Excessivevasopressin). Hypersecretion of ADH from the posterior pituitary and/or ectopic sources.

Etiology

  • Central or neurogenic DI
  • Head trauma
  • Vascular lesion
  • Centrally acting drug
  • CNS infection
  • Idiopathic DI
  • Nephrogenic DI

Risk factor

  • Head injury
  • Neurosurgery
  • Hypothalamic tumors
  • Pituitary tumors
  • Brain infection
  • Glucocorticoids
  • Narcotic antagonists
  • Lithium

Clinical manifestations

  • Genitourinary polyuria- a few liters to 18L/day.
  • Gastrointestinal- weight loss.
  • Integumentary – dry skin and mucous membranes.
  • Neurologic – mentation changes as electrolyte imbalance.

Complication

  • Hypovolemia
  • Hypotension
  • Electrolyte imbalance

Diagnosis

  • Urine output- few liters to 18l
  • Plasma osmolality increased
  • Serum Na+ increased
  • Serum Na+ decreased
  • Water deprivation study.

Surgical management

  • Hypophysectomy

Medical management

  • IVfuild, ADH replacement with DDAVP IV.

Nursing management

  1. Know which clients are at risk.
  2. Monitor intake and output
  3. Assess serum and urine value, decreased specific gravity, decreased urine osmolality, and increased serum osmolality are early indications of DI.
  4. Observe the effects of DI on concurrent medical and surgical disorders.
  5. Client and family teaching.
  6. Monitor daily weights.
  7. Monitor for hypernatremia with fluid.
  8. Evaluating neurological status.

References

  • emedicine.medscape.com/article/117648-overview
  • Mandal, G. (August 2013). A Textbook of Adult Health Nursing (2nd ed.). Dilllibazar kathmandu: Makalu publication house. Retrieved August 2013
  • www.nhs.uk/Conditions/Diabetes-insipidus/Pages/Introduction.aspx
     
Things to remember
  • A deficiency in insulin production, insulin action, or both characterizes the metabolic disease class known as diabetes mellitus.
  • A low-calorie diet can help you lose weight by creating a daily deficit of 500k.cal.
  • Insulin production by pancreatic islets is between 30 and 40 units per day.
  • Insulin sensitivity and blood sugar levels both benefit from exercise.
  • Patients with obesity can benefit from less insulin resistance if they lose weight.
  • Complications of the macrovascular system, include high blood pressure, high cholesterol, and blocked arteries.
Questions and Answers

The inability to conserve water is caused by a lack of antidiuretic hormone (ADH,vasopressin). Excessive ADH secretion from the posterior pituitary and other ectopic sources.

 

Etiology:

  • DI can be central or neurogenic.
  • Head injury
  • Vascular disease
  • Centrally acting medication
  • Infection of the CNS
  • DI that is idiopathic
  • DI that is nephrogenic

Risk factor:

  • a brain injury
  • Neurosurgery
  • umors of the hypothalamus
  • Pituitary gland tumors
  • Infection of the brain
  • Glucocorticoids
  • Antagonists of narcotics
  • Lithium

Clinical manifestations:

  • A few liters to 18L/day of genitourinary polyuria
  • Weight loss gastrointestinal.
  • Dry skin and mucous membranes are examples of integumentary disorders.
  • As an electrolyte imbalance occurs, neurologic mentation alters.

 

Nursing management:

  • Understands which clients are at risk
  • Keep track of intake and output
  • Decreased specific gravity, decreased urine osmolality, and increased serum osmolality are early indicators of DI.
  • Examine the effects of DI on concomitant medical and surgical conditions.
  • Client and family education
  • Daily weight check
  • Fluid should be used to check for hypernatremia.
  • Assessing neurological condition

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