hey everyone it's Sarah register nurse rn.com and in this video I'm going to be going over the differences between sih the syndrome of inappropriate anti-diuretic hormone versus diabetes and CPUs also called di I know a lot of people get these two conditions confused so what I want to do for you is I want to break down and the key Concepts you need to know for inlex and for your nursing lecture exams so what I'm going to do is I am going to explain how the anti-diuretic hormone works ADH because if you can understand that concept all of this other stuff like the causes the signs and symptoms and the nursing interventions will make complete sense so after this lecture I highly encourage you to go to my website register nurse rn.com and take the free quiz a link should be popping up in a card um to test your knowledge on the differences between SI ADH and Di so let's get started okay the key player in these two conditions is called the anti diuretic hormone ADH also called sometimes as vasopressin this hormone plays a huge huge role in siadh and diabetes and CPUs and they work in the opposite of them in siadh you're going to have an increase anti-diuretic hormone in di diabetes and citus you're going to have a decrease so first let's figure out the function of this hormone because if we know what it does normally then it'll help us understand what happens whenever there's too much of it or there's not enough of it okay first what is the function of ADH what it does is it plays a major role in regulating the amount of water in the body so it likes to keep your body nice and leveled with its water and it constricts blood vessels so how does this do this okay what system ask yourself what system in the body helps regulate how much water we keep and how much we lose the kidney so it accomplished this with the kidneys and what ADH does is it causes the renal tubules to retain water whenever it's being released so that's how it does it so for instance say that um you have a lot of anti-diuretic hormone in the body it's going to cause those renal renal tubules to keep water so you're going to have increased water in the body because it's not getting rid of it but if you don't have a lot of the ADH hormone anti-diuretic hormone in the body going to cause the kidneys to be like hey let's just get rid of this and you're going to be losing too much water and we'll go over this in depth here in a second but let's look at the brain because areas of the brain are responsible for regulating your anti-diuretic hormone okay in the brain you have your phalus and right below the phalus you have the hypothalmus that's where hypo comes in below so it's right below the phalus and the phalus is responsible for producing this anti-diuretic hormone so um it also plays a role in thirst whenever you get thirsty your th your thalmus kicks in and says hey let's make the body have the urge to get something to drink now right below the hypothalamus is the pituitary gland and the pituitary gland splits into two areas you have the anterior posterior uh pituitary gland and then you have the posterior pituitary gland now what we want to pay attention to is the posterior pituitary GL because this is what plays a role in your ADH secretion and storing ADH so let's cover this again because you want to remember this your hypothalamus produces anti-diuretic hormone now it signals to the posterior pituitary gland to secrete it and that is where it's stored so just commit that to memory now let's look at these two conditions since we understand how ADH works in the body let's look at what happens whenever there's too much or there's not enough of it okay first let's go over sadh again sadh stands for syndrome of inappropriate antidiuretic hormone now how do you remember which ones increase and which ones decrease that's the big issue right well how I remember it is by this little um pneumonic this AC acronym thing okay s i ADH you have the i in the middle and I just remember that I for increase ADH and then I know it's complete opposite for diabetes and CPUs so we have increase ADH here and decrease ADH here so that will help you remember and then everything else literally makes sense okay now what causes for SI ADH for this anti-diuretic hormone to be over secreted well usually what's happened is either the hypothalmus has been damaged because remember that produces our antidiuretic hormone or it's being produced some somewhere else in the body what else in the body could produce the anti-diuretic hormone mimic it well one of the number one causes of Si ADH is lung cancer it's one of the first signs that a patient actually gets they maybe will go into to the doctor they'll be presenting with this and the doctor will further look at it and we'll actually see maybe small cell lung cancer in the lungs because the cancer is causing to throw is caus in the anti-diuretic hormone to be overproduced so that is I would remember that that's a a huge cause of this condition also again damage to the hypothalamus or the P posterior pituitary gland because those are responsible for your ADH regulation infection as well can cause it any really infections in the lung such as pneumonia or in the neuros system like menitis and uh other neurosystems like gilean Beret syndrome and of course medications can cause this as well and what you want to remember one particular medication is actually used to treat diabetes and CPUs because this medication has properties to increase the diuretic hormone because again you want to increase the diuretic hormone in diabetes and CPUs but if you increase it too much you can send them in siadh and it's called dipes or the generic name is chlorpropamide and again it just has those properties that increases the diuretic anti-diuretic hor now let's look at the opposite in diabetes and CPUs what are the causes of that okay with this you have the decrease anti-diuretic hormone and usually what's causing this is there is either a problem with the kidneys because remember back in this part your kidneys are responsible for helping retain or getting rid of that water and it's sensitive to that anti-diuretic hormone whatever the antidiuretic hormone tells the kidneys to do they do it so either there's an issue with the kidneys the patient's taking a medication that's causing it or the patient's pregnant which we'll go in that here in a second usually in the last um trimester or there's been trauma to the brain or the hypothalamus of the posterior pituitary gland so um the kidneys like I said they're usually not receptive to the ADH so it's like hey we don't see any ADH anymore um so we're just going to get rid of all this fluid because remember ADH helps you keep water um damage to the hypothalamus or pituitary gland it's not working appropriately so it's not sending those right signals um drugs uh remember this drug declomycin this is actually a treatment for siadh and what it does it has properties it's part of the tetracyclin the antibiotic family but it's really a cool drug and what it does is it causes the anti-diuretic hormone to um be inhibited so it has properties to do that so if you're taking this drug it could cause diabetes and citus um just stational whenever the patient's pregnant the placenta which is responsible for producing all those hormones um can produce too much of what's called vasopress and this actually causes the anti-diuretic hormone to break down so you have no more antidiuretic hormone and the patient's just urinating like crazy and losing lots of fluids okay so how do these patients present with these conditions okay this right here it literally if you can understand anti-diuretic hormone these signs and symptoms of what you're seeing make sense just common sense okay so again let's recap siadh remember the I you have increased antidiuretic hormone antidiuretic hormone what does it do it retains water so when you are retaining too much water you're going to have water intoxication all over the body so how is this patient going to look they are going to have fluid overload too much water in the vascular system so it's going to be backing up everywhere you're going to have edema the patient's going to have drastic weight gain um high blood pressure from where you have all that extra fluid in the body and there's just way too much pressure going throughout the body you're going to have a fast heart rate from where the body is trying to compensate for all that fluid so they're going to be Tac cardic um you're going to have hyponatremia we talked about in that in the fluid and electrolytes video This is actually that uvalic hyponatremia where there's an increase of water in the body but the sodium stays the same and what's happening is that the sodium is actually diluted because of all that water so the sodium level really didn't change it just got it diluted from conserving all that water um confusion patient will be confused because they have all that water the brain tissue is very sensitive to extra water so you're going to have swelling in the brain they can be confused lethargic at risk for seizures again that goes back to the bra brain swelling uh anorexia because they are so full of water they don't want to eat probably a lot of pressure on the stomach causing them not to feel hungry and um another one this is very important they're going to have a low urine output and whenever they do urinate which isn't very often because they're conserving water remember the kidneys are like hey we have all this anti-diuretic hormone going on in the body let's not pee because we got to keep all this in the body the whenever they do urinate the urine is going to be very concentrated so another way to say urine is concentrated it's going to have a they're going to have a high urinary specific gravity so now let's flip over and let's look at the opposite because remember these two conditions present oppositely of each other okay how's this patient going to look with diabetes in CPUs they're the opposite they have not enough of the anti-diuretic hormone whenever you don't have enough your kidneys are like hey we don't have enough of this so let's lose a lot of water we're going to get rid of all this water through the renal tubules so what how do you lose water with the kidneys what do the kidneys do they cause you to urinate a lot and whenever people have diabetes and citus they urinate up to 4 lers to 24 L of fluid a day which is lots of fluid now to compensate for that they're going to have polydipsia which is increase in drinking this they're going to literally crave water and ice because they've lost all this water and the body's like hey we got to get some water back so they are going to just drink and drink and drink and try to hydrate themselves but they can't hydrate themselves because they're losing so much water through the kidneys and they're actually dehydrated you're going to see dry U mucus membranes skin is going to be dry their skin turer is going to be de decreased and they're also going to have hypotension and this is because they've literally urinated all their fluids out and there is hardly anything for the body to pump the pressure is going to be low and again remember back to the beginning um one of the things that anti-diuretic hormone does is it constricts blood vessels that's another one of its properties so um here you have the opposite you don't have enough so you have dilation when you have dilation you have low blood pressure now remember back here you had hypertension in siadh and that is again due to all the extra fluid but due to the constriction as well um here whenever because they're going to be urinating constantly like 24/7 their urine is going to be super um diluted it's not going to be concentrated so they're going to have a low urinary specific gravity and they are going to be having hypernia they're going to have a high sodium level due to losing all that fluid all that fluid's gone and all that's left is that sodium so there's going to be a lot of sodium in the body and not a lot of water now let's look at what you're going to do for this patient for your nursing interventions now to nursing management okay things you want to pay attention to this because a lot of questions like to hit on and they'll give you scenarios and you've either got to educate the patient see what statement's correct what's not side effects of drugs and things like that so you want to make sure that you're looking at the education pieces and you're looking at those common side effects for the treatment that the physician May order so let's go over this okay for both of these conditions what you're going to do is you're going to make sure that you're getting daily weights on these patients that you are watching um their intake and output very strictly if the patient's alert and oriented have them participate in this because you want to make sure that you are writing down exactly what they are taking in and putting out and there safety because these patients are definitely at risk for safety issues either in siadh due to all the brain tissue swelling water intoxication or diabetes and CPUs they're getting up urinating a lot becoming dehydrated and hypo and hypernia can um accuate that confusion okay so for SI ADH remember they have way too much fluid in the body because they have too much antidiuretic hormone which causes you to retain fluid so we are going to put them on a fluid restriction actually the doctor will order this and you will implement this and so you want to make sure that they follow the fluid restriction for diabetes and citus as the nurse you want to make sure that they are not consuming any products like familes bringing in or the patient themselves has ordered it on a tray foods that promote natural diuresis like watermelons lemons grapes foods like that that promote the body to naturally urinate and a big thing I would remember this is caffeine so teas and coffees and energy drinks things like that really promote diuresis so you don't want patients with diabetes and citus to be taking that in now typical Medical Treatments let's go over the siadh and what I would pay pay attention to is the side effects of these medications okay so our goal with SI ADH is to remove the fluid we got to get them back to a good fluid status so typically what a physician May order is a loop diuretic remember we talked a little bit about diuretics at the beginning diuretics promote diuresis and they have too much anti-diuretic hormone in this condition so they are not diuresing at all they're keeping all that water so this Lasix lasis Lasix is diuretic is going to go in um either IV or Po and cause the patient to urinate that fluid off but what you got to watch out for that is that um Loop Diuretics like to waste pottassium whenever they're urinating so watch out for hypoc caleman always check your potassium levels before you give your next dose of lasx um also sometimes with that the phys physician May order a hypertonic IV solution like 3% saline we went over this in the hypo isotonic and hypertonic video and we talked about how hyperonic Solutions work on the body and it's really neat so let's go over that real quickly what's happened remember we have way too much fluid in the body those cells are swelling and what hyperonic Solutions do they go in and they cause that fluid to be come out of that cell to shrink back down to normal and whenever that fluid comes out it's going to enter back into the vascular system so you can hopefully urinate that out with the help of that diuretic that they're also starting on as well but what you got to watch out for is the patient's already fluid water intoxicated with this condition so whenever you add the hypertonic solution onto it it you can cause more water intoxication because you're drawing all that water out to that of that cell so you've got to watch out for worsening of that fluid overload like all of a sudden you're hearing crackles they have a difficulty breathing their O2 saturations are going down things like that so watch out for that and when you give this medication usually they like to give it an ICU because it's one of those where you need to watch the patient very closely um give it slowly per your hospital protocol and usually through a central line because it's hard on the veins um another treatment um which is another popular treatment for this condition is the deom myosin we talked about that a little bit earlier this is um actually an antibiotic in the Tetra cycling family so think back to that and and what this actually does it has properties of inhibiting the antidiuretic hormone so the patient takes this and it causes that over secretion of anti-diuretic hormone to quit being so much release and it promotes diuresis so one thing you need to watch out for this is of course with the tetracyclin you do not want to give this with calcium containing foods like milk an acids because it affects how the GI system absorbs the drug now to the medical treatment of diabetes in CPUs what are what's going to be ordered by The Physicians usually for these conditions okay for a mild case of Di um it's not as popular duee to the side effects is a Dianes or the generic name chlorpropamide and what this actually is is a type 2 diabetic medication now diabetes insipidus and diabetes malius where patients have um hypoglycemia hypoglycemia things like that they require insulin is two completely different um disease processes they are not alike even though they share the name diabetes so do not get di confused with um diabetes malius okay so what does diab diabinese do diabinese um what it actually does is it increases it has properties of increasing the diuretic hormone so um but aside effect of that whenever the patient takes this they don't have diabetes but it's going to increase their diuretic hormone because they're low in the diuretic hormone they can um experience symptoms of hypoglycemia it will drop their blood sugar so remember this with this drug you've got to watch these patients glucose levels very very closely and teach them about signs and symptoms of hypoglycemia and it causes the skin to be photosensitive to the Sun so they need to cover up whenever they go outside because their skin is a lot more susceptible to Burns okay next um another treatment is a medication called deso pressin This is actually a form of vasopressin remember vasopressin is also naturally occurring in the body as the it's also called anti diuretic hormone so this is just a form of an anti-diuretic hormone replacement um so the patient takes this they can take this by mouth IV um in the nasal passages things like that and it's also called styme so um the patient will take it it's usually in extreme cases who are struggling with this and when what you need to watch for as the nurse is for signs of hyponatremia um because what you're doing is you're trying to give the patient more anti-diuretic hormone remember what does anti-diuretic hormone do do it conserves water so the patient conserving water they're at risk for getting water intoxication which will um dilute those sodium level so you need to watch out for that okay so that is about um diabetes insipidus and Si ADH now go take that quiz on my website register nurse rn.com and see how well you grasp this material and thank you so much for watching and please consider subscribing to this YouTube channel