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Dear Doctor Letter
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Diabetes Insipidus
Diabetes Insipidus should not be confused with Diabetes Mellitus, which is a
result of a deficiency of insulin. Insulin is a hormone that allows your body to
use and maintain glucose to provide energy to your cells. Diabetes Insipidus on
the other hand, is the result of a deficiency of the antidiuretic hormone, which
assists your body to
control it’s water balance.
Anatomy and Physiology:
The antidiuretic hormone (ADH) is produced in the pituitary gland, which is
situated at the base of the brain behind the nasal passages. The pituitary gland
is made up of the front (anterior) lobe and the rear (posterior) lobe where ADH
is produced. The primary function of ADH is to cause the kidneys to remove water
from the urine that is produced and return it back to the blood stream. The
amount of ADH secreted is based on the body's needs. For example, if the body is
dehydrated, the amount of ADH secreted is increased so that urine output is
decreased and water is conserved in the blood stream.
Diabetes Insipidus:
In the case of diabetes Insipidus (DI), the kidney is unable to concentrate the
urine (remove the appropriate amount of water from the urine) and there results
in a massive fluid loss from the body. There are two primary reasons for this
occurrence: (a) insufficient production or release of the antidiuretic hormone (neurogenic
or central DI) or (b) an abnormal response by the kidneys to the hormone (nephrogenic
DI). In either situation the results are a massive increase in urine output. The
cause of neurogenic DI may be familial or acquired as a result from trauma
either surgical or accidental. Nephrogenic DI is either congenital or acquired
(possibly due to a renal system damage).
Signs and Symptoms:
The most obvious symptom of DI is excessive urine output of up to 3 litres of
urine per day. The urine is very diluted and when measured the concentration of
the urine (its specific gravity) is less than 1.005 (the normal range is 1.008
to 1.030). The individual with DI will become dehydrated and show symptoms of a
dry mouth, weakness, increased heart rate, and possibly fever. As stated above,
the excess urine output results in a decrease in fluid that is available in the
body. Body fluids are made up of many components including sodium, which is used
for the transmission of impulses in nervous and muscle tissue. The body is able
to maintain the right amount of water and sodium to promote optimal functioning.
When there isn't enough water in the system, the amount of sodium becomes
concentrated, and when there is too much water in the system, the amount of
sodium becomes diluted. Both situations cause an imbalance and interfere in
proper functioning resulting in an altered level of consciousness end an
increase in seizures. If DI is not treated right away, death will occur.
Treatment:
The primary treatment goal in DI is the production of urine that is more
concentrated and to decrease the amount of urine output. The body will need to
have its fluid balance restored through the administration of IV fluids. No oral
or gastrostomy fluids should be given until the
individual's system has been stabilized. Depending on the cause of the DI,
specific medications can be administered. Urine output is measured every 30
minutes to 1 hour.
At Home:
Monitor intake and output closely
She now normally has a very large urine output
Measure body weight regularly
References
Mayo Clinic CD-ROM (f ggg)~ Mayo Foundation for Medical Education and Research.
Miller, K. L. (1996). Diabetes lnsipidus. ANNA Journal, 23 (3), 285-292.
Tortora, G. J. & Anaanostakos, N. P. (1984). Principles of Anatomy and
Physiology (4m Ed.) (PP 406-412, 675)). New York: Harper & Row.
(This information was prepared by the nurse who wrote Kayda’s care plan and
is used with her permission)
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