Diabetes insipidus

1. Diabetes Insipidus
DONE BY
SARAVANAN NIRMAL KUMAR
1527

2. DEFINITION
 It is a disorder of water metabolism caused by
deficiency of ADH (Vasopresin) or by inability of the
kidneys to respond to ADH.

3. FORMS OF DI
1. Transient DI:
Abrupt onset within first few after neuro surgery
resolve within several days.
2. Permanent DI:
Abrupt and early onset, persists for several weeks
or forever. Usually occurs after damage to
hypothalamus or Neurohypophyseal damage.

4. CONT….
3. Triphasic DI:
Immediate post injury increases Urine volume
with decrease in urine osmolity lasting 4-5days and
followed by permanent phase of polyuria.
4. Nephrogenic:
Rare Hereditary disorder acquired structural or
functional changes in kidney occurs. ADH produced
normally, but distal and collecting tubules cannot
respond.

5. CONT….
5. Complete DI:
When there is disruption of hypophyseal tract
and a complete absence of ADH.
6. Neurogenic DI:
CNS interruption of anatomic integrity of
posterior pituitary. ADH synthesis or release is
affected, may be transient or permanent.
7. Idiopathic DI:

6. ETIOLOGY
1. Primary – Idiopathic
2. Secondary
 Head trauma
 Neuro surgery
 Tumors (Intra cranial)
 Vascular
 Infection (Meningitis)
 Longstanding renal disease
 Hypokalemia.

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

8. CONT….
Note:
 Normally ADH increases kidneys permeability to water
to promote water reabsorption and decrease urine
output.
 ADH is normally released in response to increase
serum osmolality and decrease Extracellular volume.

9. CLINICAL MANIFESTATION
i.Genito Urinary :
* Polyuria (few liters to 18 l/day )
* Clear urine
* Urinary Frequency
* Nocturia
ii. Gastro Intestinal:
*Weight loss
* Polydipsia (if thirst mechanism intact 4 to
40 l/day)
* Has craving for cold water.

10. CONT….
iii.Integumentary:
*Dry skin and mucous membrane
iv. Neurologic:
* Electrolyte Imbalance
* Hypotention
v. High serum osmolality
vi. High serum sodium level.

11. DIAGNOSTIC EVALUATION
 History collection
 Physical Examination
 Water deprivation test
 Hyper-tonic Saline test
 Urine output
 Serum Na+ level
 Plasma and Serum Osmolality

12. MEDICAL MANAGEMENT
Administration of ADH or its derivative:
a) Vasopressin (Pitressin)
- IM, Effective for 24 to72hrs.
- Vial should be warmed and shaken vigorously before
administrating to mix active component settles at bottom of
vial.
b) Lypressin (Diapid nasal Spray)
- Absorbed through nasal mucosa
- Duration of action 4 to 6 hrs
- may cause chronic nasal irritation.

13. CONT….
c) Desmo-pressin acetate.
- Vasopressin deratives administered into the nose through a
soft, flexible nasal.
- Duration of action 12 to 24 hrs
- For patient who have some residual hypothalamic ADH.
d) Chloropropamide:
- Potenciate action of reducing polyuria.
e) Hydro – Chlorothiacin:
- Reduce the urine volume
- Dose 20 – 75 mg /kg/day

14. SURGICAL MANAGEMENT
1.) Hypophysectomy:-
- Removal of pituitary gland may be performed for the
treatment of primary tumor of the pituitary gland.

15. COMPLICATION
 Electrolyte imbalance
 Hypotension
 Hypovolemia
 Shock
 Death

16. NURSING DIAGNOSIS
 Risk for fluid volume deficit r/t disease process.
 Imbalanced Nutrition Less than Body Requirements
related to insufficiency of insulin, decreased
oral input.
 Fluid Volume Deficit related to osmotic diuresis.
 Risk for Infection related to hyperglycemia.