so I was doing a lecture today with one of my students actually a tutoring students I wasn't so much of lecture as it was a review but we were going over the endocrine system one of the things that comes up all the time is SIADH and di and it comes up because it can be a little bit of a cloudy idea are cloudy concept of what's happening but I promise you that I'm going to try to make this video short and sweet and painless and easy so you can understand the difference between the two now I just want to say the endocrine system is definitely one of those things that nursing students don't really like you know in nursing school it's a very busy system there's a lot of hormones to remember a lot of functions to remember the glands you know locations things of that nature but one of the things that I always like to try to encourage is that if you could master one then you can master the other and what I mean by that is the endocrine system as far as the hormone functions when it's either too much or it's too little but you're going to see just complete opposites so you're going to see opposite symptoms you're going to see opposite signs so as an example if you're able to master the concept of hyperthyroidism then know that hypothyroidism is just the complete opposite of everything that you know about hyper same thing for something like Cushing's if you're able to master Cushing's disease then just know that Addison's disease which is the opposite is going to be the exact opposite signs and symptoms that you see in Cushing's and that that idea is the same thing that you can apply to SIADH and di now we know that SIADH stands for a syndrome of inappropriate antidiuretic hormone and di stands for diabetes insipidus now diabetes insipidus is not related to diabetes mellitus so don't confuse the two they're very different so let's backtrack a little bit I drew a picture of pituitary gland my best picture I'm not Picasso so this is a pituitary gland and a is for our anterior and P is for our posterior now we know that ADH is too created from our pituitary gland right now syndrome of inappropriate antidiuretic hormone and diabetes insipidus they're both issues with ADH so let's kind of make a little guide to both the difference is is that in SIADH there is too much so here's my up arrow too much antidiuretic hormone being secreted and di it's the complete opposite it's too little and in some cases none at all now let's remember what ADH does antidiuretic hormone just just thinking about the midterm itself antidiuretic against diuresis this is our our don't pee don't pee hormone this is what controls how much reabsorption of water is happening at the level of the kidneys and how much we're actually excreting out so with that side if we are excreting too much antidiuretic hormone that means that's too much of our don't pee don't pee don't pee happening well if we are not peeing then where's the water going right so this is this is just the easiest way to think about it so what are you going to see in syndrome of inappropriate antidiuretic hormone well the first thing is you're hanging on to too much water right so that means you're going to have an increase of fluid and fluid I mean in the body right so this is going to end up being a fluid volume excess okay now I'm going to just kind of list out the signs and symptoms you're going to see in the patient I want you to think about what this means you know what this is going to turn into what other things is going to manifest too so you have too much fluid on board and syndrome of anti diary syndrome of inappropriate C's me antidiuretic hormone right too much fluid you have a fluid volume accessed someone that has fluid volume access what are you going to see in that person edema right someone that has too much fluid on board has fluid volume has got a Deema what about their blood pressure what are you going to notice in that increase right they're going to have high blood pressure in relation to the fact that they have a lot of fluid on board now if we jump over here di for a second because remember this is the complete opposite we have two little antidiuretic hormone being secreted or in some cases nothing at all in that case instead of the body hanging on to that that fluid and by fluid I want to be clear I mean water we're not talking about solutes we're just talking about the water okay so if we have too much fluid in our syndrome of antidiuretic hormone which by the way means that we have decreased urine output decrease are none at all because we've been hanging on to it and di we're going to have decreased fluid because we have increase in urine output and when I say increase these clients are patients that are suffering from di are dumping very large amounts of urine at one time we're talking up to three liters so that's a lot of fluid being lost right if here SIADH we had a fluid volume excess well then in di what do we have we have the opposite you have a fluid volume deficit okay so in this instance with SIADH if we had edema well in this instance this person is actually going to look dry right they're going to look dehydrated you might even notice that they have sunken eyes okay they're looking really dried out because they are dumping so much fluid out because the urine output is increased right they're going to be thirsty constantly thirsty because they're losing all of this fluid now these are just some of the common you know signs and symptoms that we're going to see in both of these cases and let's go ahead and compare our BP while we're here this case we had increased BP because there's a lot of fluid well in this case we're going to have decrease BP because we're losing so much of it now what I want to get to something that's really important in this case is what happens to our sodium levels because the changes in sodium that we see an SI ADH and di is what's really critical now at SIADH we have low sodium hyponatremia okay and di we have high sodium I think this is the part that gets a little bit tricky and I'll tell you why this happens remember this antidiuretic hormone that's being secreted the reabsorption of the water the too much jumping of the water it's fluid alone it's not solutes so this is the best way to explain it this is how that's what I think to explain anyway so I'm going to draw a cup so here's my cup I got up here and I'm going to put a cup over here so you can see the difference between the sodium levels now in this cup because I know I have SIADH I'm going to fill my cup with water because that's a problem right SIADH I have too much fluid and this cup I know that I keep dumping out my fluid out my water so I'm going to make my cup just have a little bit of water in it okay and so now I'm going to throw in some sodium solutes in there so here's some sodium in this one and I'm going to draw some sodium in this one now if we're looking at it which one do you think has a higher concentration of sodium and if you look clearly at it you can see well obvious right we're looking at this this has a higher concentration of sodium in it the reason why is because the amount of water versus the amount of sodium solutes is very uneven there's a higher concentration of sodium than there is water to dilute that but in this instant in our SIADH we have too much water that's diluting our sodium so as a result they become hyponatremic whereas in this case there's not enough water but there's a lot of sodium so they become hyper in a treatment so what this is what I want you to think about is the signs and symptoms that you need to be aware of or things that your patients are going to complain of that have low sodium and then have high sodium so we know that you know when sodium gets out of range now we need to look out for signs and symptoms of that confusion dizziness lethargy seizures coma you know and this is what's that what can happen as a result of these things now if you wanted to talk about treatment for a second what are the things that we have to remember for both of these so let me just change a color so we can see something different here so let's talk about treatment and we'll talk about treatment for both and it's pretty pretty simple if this person who has SIADH has too much fluid on board right not peeing enough what do we want to do we want to get rid of the fluid so something like a diuretic right a diuretic we can use to try to get that fluid off board this person that has SI ADH is definitely going to be on fluid restrictions we don't want to put more fluid on board let me know that's already an issue it's a fluid restrictions a diuretic to help get that fluid off board and then of course for both of these always treat the underlying cause excuse my handwriting it's late okay now by treating the underlying cause it means what's the issue do we have a tumor and the pituitary gland that's causing hyper or hypo secretion is there an infection going on did we take a drug that's causing it so whatever caused the issue in the first place we always want to treat that and then nd I'm just a brief little overview on treatment of that think about the exact same thing that we talked about opposite so if I'm dumping too much fluid right because I'm having a great amount of urine output then what if I gave a synthetic 88 because that that would be the point right I want to give something to try to hang on to the fluid so we can give something like a ddavp for example a synthetic ADH that we can hang on to that fluid this person that's losing so much food is not going to be on fluid restrictions but more like fluid replacement because we want to keep them adequately hydrated okay so in a nutshell this is SIADH versus di remember they're both issues of the antidiuretic hormone one is secreting too much which is this guy here SIADH and one is secreting too little or none at all which is this guy here di and so the symptoms are opposite the signs are opposite too much fluid with SIADH on board di not enough fluid we're dumping it out versus SIADH we're hanging on to it so we have a fluid volume excess in SIADH we have a fluid volume deficit in di we are a Dominus and SIADH we're dry and dehydrated and di our blood pressure is going to be elevated because of the fluid volume excess that we have an SIADH but in di we're going to have low BP right so do you level what's really critical about the to low sodium and SIADH because it's too diluted with the water we have on board versus di is going to have a high sodium level okay and the treatments based off of the symptoms space off of the signs that we're seeing we want to get rid of the fluid right we don't want to put more on board if that's our issue and the big thing for everything is to treat the underlying cause and then treat the underlying cause is really something that we can apply everywhere in nursing we always want to know what it is that's causing the issue okay so if you have any more questions on this please let me know I promise that I would do a quick little overview of s ADH versus di you know where you can reach me you can reach me on instagram @ toot RN t oo t RN you can always email me or visit me on my website at www.att.com/biz