Question

A client has sustained an injury to the head during a car accident. The doctor suspects diabetes insipidus.

a. Based on this diagnosis, what assessment data would the nurse expect to see?

b. In this situation, what would be the probable cause of this diagnosis?

c. Describe the treatment for diabetes insipidus.

d. What are the black box warnings for the prototype treatment drug?

Answer 1

a. Assess skin turgor, level of hydration of the tissue layer, pulse, blood pressure, and GCS score repeatedly.

Check urine output using an indwelling urinary catheter.

Assess fluid intake constantly (dehydration may occur).

Assess cerebral perfusion pressure (CPP), intracranial pressure (ICP), and oxygen level.

b. The acute head injury can cause weakening of the function of the hypothalamic neurons producing antidiuretic hormone (ADH), leading to post-traumatic Diabetes Insipidus.

c. Treatment includes:

• conservative management to keep the function intact (airway, breathing & circulation.)
• constant checking of fluid and electrolyte balance
• hormone replacement therapy (if urine output >250 mL/hr)

d. DESMOPRESSIN black box warning

Desmopressin acetate causes hyponatremia. If severe, it may be lethal, causes seizures, coma, and respiratory arrest. Stop using desmopressin acetate for the time being or permanently if there is hyponatremia.