ADH

Question 1

Antidiuretic Hormone

Answer 1

Too high: SADH

Too Low: Diabetes Insipidus

Question 2

SIADH

Answer 2

Symptom of inappropriate Antidiuretic Hormone

-An abnormal production or sustained secretion of ADH

Question 3

SIADH is characterized by

Answer 3

• Fluid retention
• Serum hypoosmolality and hyponatremia (dilutional)
• Concentrated urine

Question 4

SIADH Etiology

Answer 4

Malignant Tumors
-small cell carcinoma of lung

Central Nervous System Disorders
-head trauma, stroke, brain tumors

Drug Therapy
-morphine, SSRIs, chemo

Other conditions
-Hypothyroidism, infection

Question 5

SIADH: Pathogenesis

Answer 5

1. Increased ADH
2. Increased water reabsorption in renal tubules (w/o Na+)
3. Increased intravascular fluid volume
4. Dilutional hyponatremia and decreased serum osmolality

Question 6

SIADH Osmolality

Answer 6

Serum Osmolality: LOW

Urine Osmolality + Specific gravity: HIGH

Serum Sodium: LOW

Urine Output: LOW

Weight: GAIN

**patient is retaining pure water without salt

Question 7

Clinical Manifestations of SIADH depend on

Answer 7

Severity and rate of onset of hyponatremia

Question 8

Sx of Hyponatremia

Answer 8

Dyspnea, Fatigue

Neuro: confusion, lethargy, muscle twitching, convulsions, dulled sensorium

GI: impaired taste, anorexia, vomiting, cramps

Question 9

Severe Symptoms of Hyponatremia occur at

Answer 9

<100-115 mEq/L (135-145)

Possible irreversible neurologic damage

Question 10

Water intoxication

Answer 10

Sodium levels outside of cell become so low that water enters cell to follow salt, causing cell to burst.

Brain cell swelling is lethal

Question 11

Pharmacotherapy for SIADH

Answer 11

NOT the first line of treatment.

Question 12

What is treatment for SIADH?

Answer 12

Directed at the underlying cause (discontinue offending medication)

-Hypertonic saline used sometimes

Question 13

Chronic SIADH drug

Answer 13

Demeclocycline (Declomycin)

-ex) lung cancer

Question 14

Demeclocycline: class

Answer 14

Tetracycline broad-spectrum antibiotic

Question 15

Demeclocycline: USE

Answer 15

Antibiotic therapy

Treatment of SIADH

Question 16

Demeclocycline: MOA

Answer 16

Interferes w/renal response to ADH

Question 17

Demeclocycline: AE

Answer 17

Photosensitivity
Teeth staining
Nephrotoxic

Question 18

Diabetes Insipidus (DI)

Answer 18

A deficiency of ADH or a decreased renal response to ADH

Question 19

DI is characterized by

Answer 19

Excessive loss of water in urine

Question 20

2 forms of Diabetes Insipidus

Answer 20

1. Neurogenic (Central)
   - lesion in brain
2. Nephrogenic
   - kidneys don’t respond

Question 21

Neurogenic DI Cause (not injuries)

Answer 21

Hypothalamus or pituitary gland damage

Question 22

Neurogenic DI associated disorders

Answer 22

Stoke
TBI
Brain surgery
Cerebral Infections

Question 23

Neurogenic DI: Onset

Answer 23

Sudden (following injury)

Question 24

Is Neurogenic DI permanent?

Answer 24

Usually YES

Question 25

Nephrogenic DI: Cause

Answer 25

Renal Origin Loss of kidney function Often drug-related (lithium)

Question 26

Associated disorders of Nephrogenic DI

Answer 26

CKD

Question 27

Onset of nephrogenic DI

Answer 27

Slow Course: Progressive

Question 28

DI: pathogenesis

Answer 28

1. Decreased ADH 2. Decreased water reabsorption in renal tubules 3. Decreased intravascular fluid volume 4a. Increased serum osmolality (hypernatremia) AND 4b. Excessive urine output

Question 29

Diabetes Insipidus: Osmolality

Answer 29

Serum osmolality: HIGH Urine Osmolality and specific gravity: LOW Serum sodium: HIGH Urine Output; HIGH Weight: LOSS

Question 30

DI Symptoms

Answer 30

-Polyuria -Polydipsia -Dehydration -Others based on severity (electrolyte imbalances) (hypovolemic shock: Death)

Question 31

Neurogenic DI Pharmacotherapy

Answer 31

Synthetic ADH replacement

Question 32

Nephrogenic DI

Answer 32

Thiazide diuretics -seems strange but has paradoxical effect of decreasing polyuria and increases urine osmolality (No one knows why)

Question 33

Desmopressin (DDAVP): MOA

Answer 33

Synthetic ADH replacement therapy | -Antidiuretic effects

Question 34

Desmopressin (DDAVP): Route

Answer 34

Nasal Spray (Burns), PO, IV, SQ

Question 35

Desmopressin (DDAVP): AE

Answer 35

Small doses: none Nasal spray: irritation Large doses: - hyponatremia (dilutional from Inc ADH) - water intoxication (retaining water)

Question 36

DI Acronym: D-I-L-U-T-E

Answer 36

``` Dry I&O, Daily weight Low specific gravity Urinates lots Treat: vasopressin (desmopressin) rEhydrate ```