Diabetes Insipidus Flashcards
Post op patients at risk for DI
post op neuro sx for craniopharyngioma or other sx in the pituitary/hypothalamus region , TBI, ischemic brain injury, conditions causing acute brain swelling
Post op management for patients at risk DI
Na, K, Osmol, glu, BUN, creat post op and q2h, urine cath, ins and outs, notify MD if UO >4mL/kg/h over 2h or Na <138/>145
Post Op craniopharyngioma patients are at higher risk of
ACTH deficiency (90%) treat with hydrocortisone pre op/post op until well. ACTH stim test as outpt
1 mg decadron - X mg hydrocortisone
30mg
Diagnostic criteria central DI
UO >4 ml/kg/h over 2h, Na >145, Urine SG <1.005 or urine Osmol <300 mOsm/kg
Support: plasma osmol >290 mOsm/kg, no glycosuria, no renal failure
Treatment central DI
q2h lytes/BUN/creat, D5NS and 40 meq/L KCl at 400 mL/m2/day (insensible losses). Replace urine loss 1:1
if urine Na >150 give D5NS, 150-50 give D51/2NS, <50 give D5W, DDAVP 1mcg/m2/d increasing q30min until UO = 1-2 *only increase if pt still meets DI criteria. Monitor Na closely. Thyroid function one week post op.
