Page 228 - Critical Care Notes

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ENDO

Clinical Presentation
■ Symptoms may be transient, temporary, partial, or permanent
■ Polyuria or large volume of very diluted urine with a low specific gravity
(1.001–1.005) (volume does not decrease even with restricted fluids)
■ Polydipsia or extreme thirst, especially for cold water and sometimes ice or
ice water
■ Dehydration
■ Weight loss, dizziness, weakness and fatigue, sleep disturbances
■ Drowsiness, confusion, and headache may indicate water intoxication
■ Symptoms of hypovolemic shock: changes in level of consciousness (LOC),
tachycardia, tachypnea, and hypotension
Diagnostic Tests
■ Water deprivation test (Miller-Moses test)
■ Desmopressin stimulation
■ Plasma ADH
■ Plasma and urine osmolarity
■ Serum chemistries and electrolytes
■ Urinalysis including specific gravity
■ CT scan of head to detect cranial lesions
Management
■ Management of DI is highly dependent on the type.
■ Administer desmopressin (DDAVP, Stimate) for central DI; ineffective in
nephrogenic DI.
■ Administer synthetic vasopressin (Pitressin).
■ Administer chlorpropamide (Novo-Propamide).
■ Administer hydrochlorothiazide (Microzide) or indomethacin (Indocin) for
nephrogenic DI.
■ Monitor vital signs frequently.
■ Assess neurological status for changes in mentation.
■ Monitor and treat fluid and electrolyte balance.
■ Assess intake and output. Weigh daily.
■ Administer hypotonic IV fluids to match urine output.
■ Assess for water intoxication: drowsiness, lightheadedness, headache →
seizures and coma.
■ If surgery is indicated, provide emotional support to patient and family.

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