Understanding SIADH and Diabetes Insipidus

Hey everyone, it's Sarah with RegisteredNurseRN.com and in this video I'm going to be going over the differences between SIADH, the syndrome of inappropriate antidiuretic hormone, versus diabetes insipidus, 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 the key concepts you need to know for NCLEX and for your nursing lecture exams. So what I'm going to do is I am going to explain how the antidiuretic hormone works, the 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, RegisteredNurseRN.com. and take the free quiz. A link should be popping up in a card to test your knowledge on the differences between SIADH and DI. So let's get started. Okay, the key player in these two conditions is called the antidiuretic hormone, ADH, also called sometimes as vasopressin. This hormone plays a huge, huge role in SIADH and diabetes insipidus, and they work in the opposite of them. In SIADH, you're going to have an increased antidiuretic hormone. In DI, diabetes insipidus, 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 the water in the body. your body nice and level 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 accomplishes this with the kidney 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 you have a wall of antidiuretic hormone in the body. It's going to cause those 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, antidiuretic hormone in the body, it's 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 antidiuretic hormone. Okay, in the brain you have your thalamus and right below the thalamus you have the hypothalamus. That's where hypo comes in below. So it's right below the thalamus and the thalamus is responsible for producing this anti-diuretic hormone. So it also plays a role in thirst. Whenever you get thirsty your thalamus 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 p- pituitary gland. And the pituitary gland splits into two areas. You have the anterior pituitary gland and then you have the posterior pituitary gland. Now what we want to pay attention to is the posterior pituitary gland 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 antidiuretic hormone. Now it signals to to the posterior pituitary gland to secrete it and that is where it's stored. 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. First, let's go over SIADH. Again, SIADH stands for Syndrome of Inappropriate Antidiuretic Hormone. How do you remember which ones increase and which ones decrease? That's the big issue. Well, how do you remember? how I remember it is by this little mnemonic, this acronym thing. Okay, SIADH, 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 insipidus, 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 SIADH? for this antidiuretic hormone to be over secreted well usually what's happened is either the hypothalamus has been damaged because remember that produces our antidiuretic hormone or it's being produced somewhere What else in the body could produce the anti-diuretic hormone Mimic It? One of the number one causes of SIADH is lung cancer. It's one of the first signs that a patient actually gets. They maybe will go in 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 causing the anti-diuretic hormone to be overproduced so that is i would remember that that's a huge cause of this condition. Also again damage to the hypothalamus or the posterior pituitary gland because those are responsible for your ADH regulation. Infection as well can cause it. Any really infections in the lungs such as pneumonia or in the neuro system like meningitis and other neuro systems like Guillain-Barre syndrome and of course medications can cause this as well and what you'll want to remember one particular medication is actually you used to treat diabetes insipidus because this medication has properties to increase the diuretic hormone because again you want to increase the diuretic hormone in diabetes insipidus but if you increase it too much you can send them an SIADH and it's called diapenese or the generic name is chloropropamide and again it just has those properties that increases the diuretic anti-diuretic hormone. Now let's look at the opposite in diabetes insipidus. What are the causes of that? Okay. With this, you have the decreased antidiuretic hormone. 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. It's sensitive to that antidiuretic hormone. Whatever that antidiuretic hormone tells the kidneys to do, they do it. Either there's an issue with the kidneys, the patient's taking a medication that's causing it, or the patient's pregnant, which will go in... that here in a second usually in the last 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 and so we're just going to get rid of all this fluid because remember adh helps you keep water and damage to the hypothalamus or pituitary gland it's not working appropriately so it's not sending those right signals i'm driving drugs, remember this drug, Declo-myosin, this is actually a treatment for SIADH and what it does, it has properties, it's part of the tetracycline, the antibiotic family, but it's really a cool drug and what it does is it causes the anti-diuretic hormone to be inhibited. So it has properties to do that. So if you're taking this drug, it could cause diabetes insipidus. Just Stational, whenever the patient's pregnant, the placenta, which is responsible for producing all. all those hormones can produce too much of what's called vasopressinase. And this actually causes the antidiuretic 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 the antidiuretic 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's 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, 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's trying to compensate for all that fluid, so they're going to be tachycardic. You're going to have hyponatremia, we talked about that in the fluid and electrolytes video. This is actually that euvolemic hyponatremia where there's an increase of water in the 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 diluted from conserving all that water and confusion patient will be confused because they have all that water the brain tissue is very sensitive to extra water so you're gonna have swelling in the brain they can be confused lethargic at risk for seizures again that goes back to the brain swell 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 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 So now let's flip over and let's look at the opposite because remember these two conditions present oppositely of each other. How is this patient going to look with diabetes insipidus? They're the opposite. They have not enough of the antidiuretic 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. 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 insipidus, they urinate up to four liters or 24 liters 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. 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 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 mucous membranes. Skin is going to be dry. Their skin turgor is going to be decreased. And they're also going to have hypotension. And this is because they've literally urinated all their fluids out and there's hardly anything for the body to pump. The pressure's going to be low. And again, remember back to the beginning, one of the things that anti-diuretic hormone does is it constricts blood vessels. That's another one of its properties. So 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 and SIADH. And that is again due to all the extra fluid, but due to the constriction as well. And here, because they're going to be urinating constantly, like 24-7, their urine is going to be super diluted. It's not going to be concentrated. So they're going to have a a low urinary specific gravity and they are going to be having hypernatremia. They're going to have a high sodium level due to losing all that fluid. All that fluid is 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 and 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 their intake and output very strictly if the patient's alert and orange And granted, 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's 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 insipidus. They're getting up urinating a lot, they're becoming dehydrated, and hypo and hypernatremia can extenuate that confusion. Okay so for SIADH remember they have way too much fluid in the body because they have too much anti-diuretic hormone which causes you to retain fluid. So we're 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 insipidus as the nurse you want to make sure that they are not consuming any products like families 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 insipidus to be taking that in. Now typical medical treatments, let's go over the SIADH and what I would pay attention to is the side effects of these medications. Okay, so our goal with SIADH 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, Lasix is a loop diuretic, It's going to go in either IV or PO and cause the patient to urinate that fluid off. But what you've got to watch out for that is that loop diuretics like to waste potassium whenever they're urinating. So watch out for hypokalemia and always check your potassium levels before you give your next dose of Lasix. Also, sometimes with that, the physician may order a hypertonic IV solution like 3% saline. We went over this in the hypo, isotonic, and hypertonic video. We talked about how hypertonic 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 hypertonic solutions do, they go in and they cause that fluid to 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've 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, you can cause more water intoxication because you're drawing all that water out of that cell. So you've got to watch out for worsening of that fluid overload. All of a sudden you're hearing crackles. They have 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 and give it slowly per your hospital protocol and usually through a central line because it's hard on the veins. Another treatment, which is another popular treatment for this condition, is the declomycin. We talked about that a little bit earlier. This is actually an antibiotic in the tetracycline family. So think back to that. And what this actually does, it has properties of inhibiting the anti-diuretic hormones. So the patient takes this and it causes that over- secretion of antidiuretic 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 tetracyclines you do not want to give this with calcium containing foods like milk and acids because it affects how the GI system absorbs the drug. Now to the medical treatment of diabetes insipidus. What's going to be ordered by the physicians usually for these conditions? Okay for a mild case of DI It's not as popular due to the side effects is a dipenese or the generic name chloropropamide. And what this actually is, is a type two diabetic medication. Now diabetes insipidus and diabetes mellitus, where patients have hyperglycemia, hypoglycemia, things like that, they require insulin. It's two completely different disease processes. They are not alike, even though they share the name diabetes. So do not get DI confused. with diabetes mellitus. What does diabetes do? What it actually does is it has properties of increasing the diuretic hormone. A side 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 experience symptoms of hypoglycemia. It will drop their blood sugar. Remember this. 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. Another treatment is a medication called desopressin. This is actually a form of vasopressin. Remember, vasopressin is also naturally occurring in the body as the, it's also called. antidiuretic hormone so this is just a form of an antidiuretic hormone replacement and so the patient takes this they can take this by mouth IV and the nasal passages things like that and it's also called stymie so 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 and because what you're doing is you're trying to to give the patient more antidiuretic hormone. Remember what does antidiuretic hormone do? It conserves water. So the patient's conserving water, they're at risk for getting water intoxication, which will dilute those sodium levels. So you need to watch out for that. Okay, so that is about diabetes insipidus and SIADH. Now go take that quiz on my website, registernurserion.com and see how well you grasp this material. Thank you so much for watching and please consider subscribing to this YouTube channel.

So what I'm going to do is I am going to explain how the antidiuretic hormone works, the 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, RegisteredNurseRN.com. and take the free quiz.

A link should be popping up in a card to test your knowledge on the differences between SIADH and DI. So let's get started. Okay, the key player in these two conditions is called the antidiuretic hormone, ADH, also called sometimes as vasopressin. This hormone plays a huge, huge role in SIADH and diabetes insipidus, and they work in the opposite of them.

In SIADH, you're going to have an increased antidiuretic hormone. In DI, diabetes insipidus, 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 the water in the body.

your body nice and level 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 accomplishes this with the kidney 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 you have a wall of antidiuretic hormone in the body. It's going to cause those 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, antidiuretic hormone in the body, it's 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 antidiuretic hormone.

Okay, in the brain you have your thalamus and right below the thalamus you have the hypothalamus. That's where hypo comes in below. So it's right below the thalamus and the thalamus is responsible for producing this anti-diuretic hormone. So it also plays a role in thirst. Whenever you get thirsty your thalamus 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 p- pituitary gland. And the pituitary gland splits into two areas. You have the anterior pituitary gland and then you have the posterior pituitary gland.

Now what we want to pay attention to is the posterior pituitary gland 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 antidiuretic hormone. Now it signals to to the posterior pituitary gland to secrete it and that is where it's stored.

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. First, let's go over SIADH. Again, SIADH stands for Syndrome of Inappropriate Antidiuretic Hormone.

How do you remember which ones increase and which ones decrease? That's the big issue. Well, how do you remember? how I remember it is by this little mnemonic, this acronym thing.

Okay, SIADH, 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 insipidus, 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 SIADH? for this antidiuretic hormone to be over secreted well usually what's happened is either the hypothalamus has been damaged because remember that produces our antidiuretic hormone or it's being produced somewhere What else in the body could produce the anti-diuretic hormone Mimic It?

One of the number one causes of SIADH is lung cancer. It's one of the first signs that a patient actually gets. They maybe will go in 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 causing the anti-diuretic hormone to be overproduced so that is i would remember that that's a huge cause of this condition. Also again damage to the hypothalamus or the posterior pituitary gland because those are responsible for your ADH regulation. Infection as well can cause it. Any really infections in the lungs such as pneumonia or in the neuro system like meningitis and other neuro systems like Guillain-Barre syndrome and of course medications can cause this as well and what you'll want to remember one particular medication is actually you used to treat diabetes insipidus because this medication has properties to increase the diuretic hormone because again you want to increase the diuretic hormone in diabetes insipidus but if you increase it too much you can send them an SIADH and it's called diapenese or the generic name is chloropropamide and again it just has those properties that increases the diuretic anti-diuretic hormone. Now let's look at the opposite in diabetes insipidus.

What are the causes of that? Okay. With this, you have the decreased antidiuretic hormone.

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. It's sensitive to that antidiuretic hormone. Whatever that antidiuretic hormone tells the kidneys to do, they do it.

Either there's an issue with the kidneys, the patient's taking a medication that's causing it, or the patient's pregnant, which will go in... that here in a second usually in the last 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 and so we're just going to get rid of all this fluid because remember adh helps you keep water and damage to the hypothalamus or pituitary gland it's not working appropriately so it's not sending those right signals i'm driving drugs, remember this drug, Declo-myosin, this is actually a treatment for SIADH and what it does, it has properties, it's part of the tetracycline, the antibiotic family, but it's really a cool drug and what it does is it causes the anti-diuretic hormone to be inhibited. So it has properties to do that.

So if you're taking this drug, it could cause diabetes insipidus. Just Stational, whenever the patient's pregnant, the placenta, which is responsible for producing all. all those hormones can produce too much of what's called vasopressinase.

And this actually causes the antidiuretic 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 the antidiuretic 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's 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, 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's trying to compensate for all that fluid, so they're going to be tachycardic.

You're going to have hyponatremia, we talked about that in the fluid and electrolytes video. This is actually that euvolemic hyponatremia where there's an increase of water in the 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 diluted from conserving all that water and confusion patient will be confused because they have all that water the brain tissue is very sensitive to extra water so you're gonna have swelling in the brain they can be confused lethargic at risk for seizures again that goes back to the brain swell 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 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 So now let's flip over and let's look at the opposite because remember these two conditions present oppositely of each other. How is this patient going to look with diabetes insipidus?

They're the opposite. They have not enough of the antidiuretic 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. 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 insipidus, they urinate up to four liters or 24 liters 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. 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 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 mucous membranes.

Skin is going to be dry. Their skin turgor is going to be decreased. And they're also going to have hypotension.

And this is because they've literally urinated all their fluids out and there's hardly anything for the body to pump. The pressure's going to be low. And again, remember back to the beginning, one of the things that anti-diuretic hormone does is it constricts blood vessels. That's another one of its properties.

So 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 and SIADH.

And that is again due to all the extra fluid, but due to the constriction as well. And here, because they're going to be urinating constantly, like 24-7, their urine is going to be super diluted. It's not going to be concentrated.

So they're going to have a a low urinary specific gravity and they are going to be having hypernatremia. They're going to have a high sodium level due to losing all that fluid. All that fluid is 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 and 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 their intake and output very strictly if the patient's alert and orange And granted, 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's 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 insipidus. They're getting up urinating a lot, they're becoming dehydrated, and hypo and hypernatremia can extenuate that confusion. Okay so for SIADH remember they have way too much fluid in the body because they have too much anti-diuretic hormone which causes you to retain fluid. So we're 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 insipidus as the nurse you want to make sure that they are not consuming any products like families 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 insipidus to be taking that in. Now typical medical treatments, let's go over the SIADH and what I would pay attention to is the side effects of these medications.

Okay, so our goal with SIADH 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, Lasix is a loop diuretic, It's going to go in either IV or PO and cause the patient to urinate that fluid off. But what you've got to watch out for that is that loop diuretics like to waste potassium whenever they're urinating.

So watch out for hypokalemia and always check your potassium levels before you give your next dose of Lasix. Also, sometimes with that, the physician may order a hypertonic IV solution like 3% saline. We went over this in the hypo, isotonic, and hypertonic video. We talked about how hypertonic 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 hypertonic solutions do, they go in and they cause that fluid to 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've 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, you can cause more water intoxication because you're drawing all that water out of that cell. So you've got to watch out for worsening of that fluid overload. All of a sudden you're hearing crackles.

They have 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 and give it slowly per your hospital protocol and usually through a central line because it's hard on the veins.

Another treatment, which is another popular treatment for this condition, is the declomycin. We talked about that a little bit earlier. This is actually an antibiotic in the tetracycline family. So think back to that. And what this actually does, it has properties of inhibiting the anti-diuretic hormones.

So the patient takes this and it causes that over- secretion of antidiuretic 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 tetracyclines you do not want to give this with calcium containing foods like milk and acids because it affects how the GI system absorbs the drug. Now to the medical treatment of diabetes insipidus. What's going to be ordered by the physicians usually for these conditions?

Okay for a mild case of DI It's not as popular due to the side effects is a dipenese or the generic name chloropropamide. And what this actually is, is a type two diabetic medication. Now diabetes insipidus and diabetes mellitus, where patients have hyperglycemia, hypoglycemia, things like that, they require insulin. It's two completely different disease processes.

They are not alike, even though they share the name diabetes. So do not get DI confused. with diabetes mellitus.

What does diabetes do? What it actually does is it has properties of increasing the diuretic hormone. A side 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 experience symptoms of hypoglycemia. It will drop their blood sugar.

Remember this. 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. Another treatment is a medication called desopressin.

This is actually a form of vasopressin. Remember, vasopressin is also naturally occurring in the body as the, it's also called. antidiuretic hormone so this is just a form of an antidiuretic hormone replacement and so the patient takes this they can take this by mouth IV and the nasal passages things like that and it's also called stymie so 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 and because what you're doing is you're trying to to give the patient more antidiuretic hormone.

Remember what does antidiuretic hormone do? It conserves water. So the patient's conserving water, they're at risk for getting water intoxication, which will dilute those sodium levels.

So you need to watch out for that. Okay, so that is about diabetes insipidus and SIADH. Now go take that quiz on my website, registernurserion.com and see how well you grasp this material.

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Transcript for:Understanding SIADH and Diabetes Insipidus

Transcript for:
Understanding SIADH and Diabetes Insipidus