Question

Case #1: Diabetes Insipidus Case Study

Case Scenario: BD is a 40-year-old Caucasian male brought to the ED following a head injury in a motorcycle accident.  BD was stabilized and sent to the ICU for observation.  On Day 3 in the ICU, BD’s vital signs and lab studies are reported to the day shift nurse as:

• B/P 84/54 P- 128 R-20 SaO2- 94% T- 99.2 (oral).
• Urine output for the past 24 hours: 8,050 ml.
• Na: 164 K: 3.2 Cl: 99

The night shift nurse reports that BD is more lethargic than last evening and has complaints of generalized weakness.  You begin your nursing assessment and note that he is pale and slightly confused.  BD is diagnosed with central diabetes insipidus.

1. Discuss the role of Antidiuretic hormone (ADH) in the development of diabetes insipidus.
2. Based on the report from the night nurse, what are your nursing priorities for BD?
3. Discuss the goals of management when treating diabetes insipidus. Include the nurse’s role.
4. Review the medication used in the treatment of diabetes insipidus. What medication should the nurse expect to see ordered in the treatment? What are the nursing implications while administering these drugs?

Answer 1

Answers:

· 1) ADH is also called arginine vasopressin. It's a hormone made by the hypothalamus in the brain and stored in the posterior pituitary gland. It tells kidneys how much water to conserve.

ADH constantly regulates and balances the amount of water in your blood. Higher water concentration increases the volume and pressure of your blood. Osmotic sensors and baroreceptors work with ADH to maintain water metabolism.

A rare water metabolism disorder called central diabetes insipidus is sometimes the cause of ADH deficiency. Central diabetes insipidus is marked by a decrease in either the production of ADH by your hypothalamus or the release of ADH from your pituitary gland.

People with central diabetes insipidus are often extremely tired because their sleep is frequently interrupted by the need to urinate. Their urine is clear, odorless, and has an abnormally low concentration of particles.

Central diabetes insipidus can lead to severe dehydration if it’s left untreated. Your body won’t have enough water to function.

2) Diabetes insipidus (DI) is a disorder in which there is an abnormal increase in urine output, fluid intake and often thirst. It causes symptoms such as urinary frequency, nocturia (frequent awakening at night to urinate) or enuresis (involuntary urination during sleep or “bedwetting”). Urine output is increased because it is not concentrated normally.

- Priority Nursing Care:
- Deficient Fluid Volume
- Risk for Impaired Skin Integrity
- Deficient Knowledge

3) Fluid retention & replacement is the main goal as diabetes insipidus has frequent urination.

- Monitor fluid & electrolyte imbalance

- Maintaining skin & tissue integrity as frequency of urination is increased.

- Deficient knowledge to overall condition

- Dietary modification: low salt diet.

4) For central and pregnancy-related diabetes insipidus, drug treatment can correct the fluid imbalance by replacing vasopressin. For nephrogenic diabetes insipidus, the kidneys will require treatment.

- Vasopressin hormone replacement uses a synthetic analog of vasopressin called desmopressin.

- The drug is available as a nasal spray, injection, or tablet, and is taken when needed.

Nephrogenic diabetes insipidus treatments may include:

anti-inflammatory medicines, such as non-steroidal anti-inflammatory drugs (NSAIDS)
diuretics, such as amiloride and hydrochlorothiazide reducing sodium intake and increasing water intake.

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