CHARLES Z. ARIOLA JR., MSN., LPT, RN.

INSTRUCTOR I
 NEUROHYPOPHYSIS
- refers to the disorders of the posterior pituitary
gland
- related to the deficiency or excess in Antidiuretic
hormone or vasopressin
- common disorders include the Diabetic Insipidus
and Syndrome of Inappropriate Antidiuretic
Hormone
 DIABETIC INSIPIDUS
- is a water meotabolism problem caused by ADH
deficiency (either a decrease in ADH sysnthesis or
inability of the kidneys to respond to ADH)
- results in excretion of large volumes of dilute
urine .
- distal kidney tubules and collecting ducts do not
reabsorb water , which leads to POLYURIA and
DEHYDRATION
 CLASSIFICATION OF DIABETIC INSIPIDUS
1. NEPHROGENIC DIABETIC INSIPIDUS
- inherited disorder
-the renal tubules do not respond to the actions of
ADH which results in poor reabsorption by the
kidneys
 CLASSIFICATION OF DIABETIC INSIPIDUS
2. PRIMARY DIABETES INSPIDUS
- caused by a defect in the hypothalamus or pituitary
resulting in lack of ADH production or release
3. SECONDARY DIABETES INSIPIDUS
- results from tumors in or near the hypothalamus or
pituitary gland, head trauma, infectious process,
surgical procedures (hypophysectomy) or metastic
tumors.
 CLASSIFICATION OF DIABETIC INSIPIDUS
4. DRUG-RELATED DIABETES INSIPIDUS
- usually caused by lithium carbonate (Eskalith,
Lithobid, carbolith) and Demeclocycline (Declomycin)
which interfere with the response of kidneys to ADH.
 ASSESSMENT
1. CARDIOVASCULAR MANIFESTATIONS
- hypotension
- decreased pulse pressure
- tachycardia
- peripheral pulses weak, easily obliterated
- Increased Hgb
-Increased hct
- Increased bUN
 ASSESSMENT
2. RENAL/URINARY MANIFESTATIONS
- Increased urine output
- dilute and low specific gravity
- hypo-osmolar
3. INTEGUMENTARY MANIFESTATIONS'
- poor turgor
- dry mucous membranes
 ASSESSMENT
4. NEUROLOGICAL MANIFESTATIONS
- increased sensation of thirst
- decreased cognition
- hyperthermia
- lethargy to coma
- ataxia
 OTHER ASSESSMENT
24 hour measurement of intake and output
SIGNIFICANCE:
- DI is considered if urine output is more than 4L during
thsi period
- volume of urine output is expected 4 to 30 L/day
- urine is dilute and low specific gravity
- low osmolarity (50 to 200 mOsm/kg)
 INTERVENTIONS
MEDICAL MANAGEMENT
- aimed at controlling manifestations with drug therapy

1. CHLORPROPRAMIDE (Diabinese, Novo-Propramide)

- given for partial deficit of ADH
- It increases the action of existing ADH
 INTERVENTIONS
2. DESMOPRESSIN (DDAVP)synthetic from of vasopressin
given for a severe ADH deficiency
- drug of choice
- given orally or intranasal in metered spray
- teach patient that every metered spray delivers 10mcg and
those with mild condition may need only one or two sprays for
24 hours.
- severe case may need two to three sprays
 INTERVENTIONS
- for severe dehydration, IV or IM Desmopressin may be given
- ulceration of the mucous membranes, allergy, chest tightness
and pulmonary inhalation of the spray maoy occur with the
use of intranasal preparati
 INTERVENTIONS
- measure fluid intake
- check urine output and specific gravity
- weigh the client daily
- urge patient to drink fluid equal to the amount of urine
output
- lifelong Desmopressin is given for patient with permanent DI
- assess patient ability to follow instructions
- polyuria and polydipsia are signals for another dose
 SYNDROME OF INAPPROPRIATE
ANTIDIURETIC HORMONE
- a problem of excessive secretion of ADH
- also known as Schwartz-Bartter Syndrome
- occurs with many pathologic conditions such as drug related
like Selective Serotonin Reuptake Inhibitors (SSRIs)
- the feedback mechanisms that regulate ADH do not function
properly which causes water retention and dilutional
Hyponatremia
 ASSESSMENT
- early manifestation includes water retention
- GI disturbances such as loss of appetite, nausea and
vomiting
- water retention, hyponatremia dn fluid shifts affect central
nervous system especiall when the sodium level drops to below
115 mEq/L
- patient may have lethargy, headaches, disorientation and
change in level of consciousness
- progession of condition may cause seizure and coma.
 ASSESSMENT
- vitals sign changes include tachycardia (from increased fluid
volume) and hypothermia (caused by central nervous system
disturbance)
 INTERVENTIONS
MEDICAL INTERVENTION
1. Restricting Fluid Intake
2. Promoting Excretion of water
3. Replacing sodium lost
4. Interfering with the action of ADH
 INTERVENTIONS
FLUID RESTRICTION
- 500 to 600 mL/24 hr
- dilute tube feedings with saline rather than plain watera
nd use saline to irrigate tubes
- measure patient daily to assess degree of fluid restriction
needed
 INTERVENTIONS
DRUG THERAPY
- diuretics may be needed especially with heart failure results from
fluid overload
- be aware of sodium loss which can further potentiate SIADH
- Hypertonic saline may be used such as 3% NaCL
DEMECLOCYCLINE (Declomycin)
- available as oral agent and is antibiotic
- one side effect is candidiasis
 INTERVENTIONS
MONITORING
- monitor patient's response to therapy
- monitor indicators for fluid overload such as neck vein distention,
crackles in the lungs, edema and reduced urine output at least every 2
hours
PROVIDING SAFE ENVIRONMENT
- needed when the serum sodium level falls below 120 mmol
- possible neurologic changes like seizures may occur
- check orientation