DI

1. Diabetes
Insipidus
Subtitle

2. INTRODUCTION
Diabetes insipidus (DI) is a rare condition that occurs when your
kidneys are not able to conserve water. DI is not related to diabetes
mellitus, which is often referred to simply as diabetes. That means
you can have DI without having diabetes. In fact, the condition can
occur in anyone.

3. DEFINITION
It is a disorder of water metabolism caused by
deficiency of ADH

4. INCIDENCE
Approximately 1 in 30,000 children has diabetes
insipidus.

5. TYPES OF DIABETES INSIPIDUS
DIABETES
INSIPIDUS
Central Nephrogenic Dipsogenic Gestational

6. Central diabetes insipidus.
With this type, not enough ADH is made or secreted.
This is most often because of damage to the
hypothalamus or pituitary gland. Typical causes
include injury to the brain and rare genetic disorders.

7. Nephrogenic diabetes insipidus.
With this type, the kidneys don’t respond normally
to ADH. This is most often because of medicines or
chronic disorders. Some genetic disorders can
affect the kidneys from birth. Other causes of
kidney problems include kidney failure, sickle cell
disease, and polycystic kidney disease

8. Dipsogenic diabetes insipidus.
This is caused by a problem with your child's sense
of thirst. It causes your child to be abnormally
thirsty and drink a lot. Your child then produces
more urine.

9. gestational diabetes insipidus.
This occurs only during pregnancy and usually goes
away after your baby is born. It may come back if
you have another pregnancy.

10. ETIOLOGY & RISKFACTORS
A hypothalamus gland that doesn’t make enough
ADH
A pituitary gland that doesn’t release enough ADH
into the blood
Damage to the hypothalamus or pituitary gland
during surgery or radiation therapy
Brain injury
Brain tumor

11. CONTI...
Blockage in the arteries leading to the brain
Inflammation of the brain (encephalitis)
Inflammation of the membranes that cover the brain
and spinal cord (meningitis)
Sarcoidosis
Family heredity

12. PATHOPHYSIOLOGY
Due to etiological factor
Deficiency of ADH
Excretion of large volumes of
hypotonic fluid
Permeability of water is diminished

13. CLINICAL MANIFESTATION
oHeavy, wet diapers
oBed-wetting
oTrouble sleeping
oFever
oVomiting
oConstipation
oDelayed growth
oWeight loss

14. DIAGNOSTIC EVALUATION
▪ Urine tests. For this test, a child will not drink for
several hours (or after midnight while asleep). He or
she will then urinate twice within 1 hour. The second
urine specimen can often diagnose the condition.
▪ Blood test. This is done to measure salt (sodium)
levels in the blood.

15. CONTI...
• Water deprivation test. This test is done in the
hospital. It checks if dehydration occurs while a child
doesn’t eat or drink.
• MRI. This test uses a large magnets and a computer to
make detailed images of tissues in the body. The test is
done to look for problems with the pituitary gland.

16. MANAGEMENT
Goal
1. To maintain normal fluid regulation
2. To reduce signs and symptoms.

17. MEDICAL MANAGEMENT
PHARMACOLOGICAL MANAGEMENT
▪ Modified antidiuretic hormone medications, such as
desmopressin (DDAVP), taken as a pill, injection or nasal
spray
▪ non-steroidal anti-inflammatory drugs (NSAIDS) like
ibuprofen and water pills
▪ nephrogenic diabetes insipidus, the treatment options
are anti-inflammatory medications and diuretics (water
pills)

18. CONTI...
NON PHARMACOLOGICAL MANAGEMENT
Provide plenty of fluids.
Monitor child’s fluid intake and urine output.
check the amount of sodium in blood often to make sure
the medicine dose is correct.

19. SURGICAL MANAGEMENT
Hypophysectomy
surgical removal of the pituitary gland

20. NURSING
MANAGEMENT

21. Assessment
1. asses the general condition of the patient
2. assess skin for dehydration like poor turgour,
flushing and dry mucus membrane

22. NURSING DIAGNOSIS
1. Risk for fluid volume deficit r/t disease process.
2. Imbalanced Nutrition less than Body Requirements
related to insufficiency of insulin , decreased oral input.
3. Fluid Volume Deficit related to osmotic diuresis.
4. Risk for Infection related to hyperglycemia.

23. Nursing Interventions
• Maintaining Fluid and Electrolyte Balance
• Increasing Knowledge About Diabetes Management
• Monitoring and Managing Potential Complications
• Teaching Patients Self-Care

24. HEALTH EDUCATION
▪ Emphasize importance of closely monitoring fluid and electrolyte
balance
▪ Encourage family involvement for successful home management
▪ Begin log of accurate intake, output, and daily weight while child is
still hospitalized for family to continue at home
▪ Teach parents to replace fluids in very young child of infant
because these patients cannot accurately express thirst or obtain a
drink independently

25. COMPLICATION
Brain damage Restlessness Poor growth
Impaired
mental
function
Hyperactivity
Short
attention
span

26. CONCLUSION
Diabetes insipidus is a rare disorder which leads to an
imbalance of fluids within the body and this imbalance
makes you very thirsty even after having something to
drink. Because of the vast water intake, it leads you to
need to frequently pass large quantities of urine.