Hi, I'm Cathy with Level Up RN. In this video, I will be discussing diabetes insipidus and SIADH. And at the end of the video, I have a great little quiz for you guys so you can test your understanding of these two disorders. And if you have our Level Up RN pediatric nursing flashcards, definitely pull out your flashcards so you can follow along with me and pay close attention to the bold red text on the cards because those represent the most important facts that you are likely to get tested on in nursing school. Before we get into details about diabetes insipidus and SIADH, let's first review the role of ADH in the body. So ADH is antidiuretic hormone, and it is secreted by the posterior pituitary gland in the brain. Release of ADH causes the reabsorption of water in the kidneys. So with diabetes insipidus, we either have neurogenic DI or nephrogenic DI. With neurogenic DI, we have insufficient ADH being released by the pituitary gland. With nephrogenic DI, ADH is being released just fine from the pituitary gland, but the kidneys are not responding appropriately to the ADH. Whether we're talking about neurogenic or nephrogenic diabetes insipidus, the result is the same, which is the kidneys are not reabsorbing water, and instead, the water is being excreted in the urine.
So the hallmark symptom of diabetes insipidus is the patient peeing lots and lots of dilute urine. And because they're losing all that water in their urine, they will exhibit signs and symptoms of dehydration, such as increased thirst, decreased skin turgor, hypotension, dry mucous membranes, and sunken fontanelles. So our cool chicken hint to help you remember that dehydration is a key symptom of diabetes insipidus is with diabetes insipidus, your patient will want to sip a lot of water. In terms of labs, the patient's urine will be very dilute. So we will have a decrease in urine specific gravity, a decrease in urine osmolality, as well as a decrease in sodium levels in the urine. On the other hand, the patient's blood will be concentrated. So we will have an increase in blood osmolality as well as an increase in sodium levels in the blood. Besides blood and urine tests, another key test used in the diagnosis of diabetes insipidus is a water deprivation test. So this test pretty much works like it sounds. So we deprive the patient of water for a period of time, and we see if the patient's kidneys are able to concentrate urine.
Treatment of neurogenic diabetes insipidus includes administration of a synthetic form of ADH, such as vasopressin or desmopressin. So our cool chicken hint to help you remember these medications is vasopressin or desmopressin will help to suppress all that urine. As the nurse, when caring for a patient with diabetes insipidus, you, of course, want to monitor their intake and output and their daily weight, as well as their urine specific gravity.
Moving on to SIADH now, which is syndrome of inappropriate antidiuretic hormone, this disorder causes excess release of ADH from the posterior pituitary gland, which in turn causes the kidneys to increase reabsorption of water. Causes of SIADH include a brain tumor, head injury, or infection such as meningitis. In terms of signs and symptoms, because the patient will be reabsorbing all that water, they will be peeing very little. So they will have small amounts of concentrated urine. And because they have all that extra fluid on the body, they will have signs and symptoms of fluid volume excess, such as hypertension, tachycardia, crackles, jugular vein distention, and weight gain. So our cool chicken hint to help you remember this disorder is with SIADH, you will be super inflated, so SI, with all that extra fluid. And then with all that extra fluid in the blood, this will cause dilutional hyponatremia, which may cause confusion in the patient and will place the patient at increased risk for seizures. In terms of labs, the patient's urine will be concentrated. So we will have an increase in urine specific gravity, urine osmolality, as well as sodium levels in the urine. On the other hand, the blood will be dilute. So we will have a decrease in blood osmolality as well as a decrease in sodium levels.
Treatment of SIADH includes addressing any underlying condition that is contributing to the disorder, such as a brain tumor. Fluid restriction is going to be key when treating SIADH. And then diuretics can be used to help promote water excretion, and hypertonic saline can be administered in order to bring up the patient's sodium levels. As the nurse, you want to monitor your patient's intake and output as well as their daily weight. And then due to the presence of hyponatremia, we also need to monitor our patient's neurologic status and implement seizure precautions.
All right. It's quiz time. With this particular quiz, I'm going to give you a key fact about diabetes insipidus or SIADH. And you need to tell me which one I'm talking about. So the answer will be DI or SIADH. Are you guys ready? Let's go.
Number 1, this disorder causes small amounts of concentrated urine. The answer is SIADH.
Number 2, urine specific gravity will be increased with this disorder. The answer is SIADH.
Number 3, this disorder is treated with desmopressin. The answer is diabetes insipidus.
Number 4, this disorder may place the patient at increased risk for seizures. The answer is SIADH.
Number 5, this disorder will result in signs and symptoms of dehydration. The answer is diabetes insipidus.
Number 6, this disorder causes an increase in blood osmolality. The answer is diabetes insipidus.
Number 7, fluid restriction is part of the treatment plan for this disorder. The answer is SIADH.
And Number 8, a water deprivation test is used to help diagnose this disorder. The answer is diabetes insipidus. Okay. That is it for this video. I hope you found it to be helpful. Take care and good luck with studying.
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Let's first [inaudible].
