Diabetes insipidus
Diabetes insipidus is an uncommon condition in which the kidneys are unable to prevent the excretion of water. ( Medlineplus,2015)
Diabetes insipidus is affect to body makes a substance called antidiuretic hormone (ADH). It’s produced in a part of your brain called the hypothalamus and stored in your pituitary gland. It tells your kidneys to hold onto water, which makes your urine more concentrated. ( WebMD, 2015)
Incidence and prevalence of the disease worldwide and in Thailand.
1. In Thailand can not find report about Diabetes Insipidus.
2. DI is uncommon in the United States, with a prevalence of 3 cases per 100,000 population. No significant sex-related differences in central or nephrogenic DI exist, with male and female prevalence being equal. Similarly, no significant differences in prevalence among ethnic groups have been found.With both central and nephrogenic DI, inherited causes account for approximately 1-2% of all cases. An incidence of about 1 in 20 million births for nephrogenic DI caused by AQP2 mutations has been cited. ( Medscape , 2015 )
3. The period prevalence rate of CDI in Denmark over the 5-year period investigated was 23 CDI patients per 100 000 inhabitants, with a higher prevalence in children and older adults (>80 years of age). The 1-year period prevalence rate of CDI decreased in Denmark over the 5 years from approximately 10 to 7 CDI patients per 100 000 inhabitants. The yearly incidence rate of new cases of CDI was found to be 3 to 4 patients per 100 000. The incidence of (presumable) congenital CDI was found to be 2 infants per 100 000 infants. Half of the patients with CDI prescribed as oral treatment were provided dosing instructions to only administer the drug before bedtime, and one third of the CDI patients either had no specific instructions or were instructed to use the drug as needed. Hospital admissions due to severe hyponatremia occurred in 0.9% of patients over a 5-year period, predominantly in females with an incidence ratio of women to men of 1.8:1. ( PubMed.ORG , 2013 )
Risk factor
Diabetes insipidus has several causes. In some people, a part of the brain (hypothalamus) doesn't make enough antidiuretic hormone (ADH). ADH helps your body balance water in the urine and blood. In other cases, the pituitary gland doesn't release enough of the hormone. Damage to either the hypothalamus or the pituitary gland can cause diabetes insipidus.This can occur after a head injury, during brain surgery or when a tumor grows on the glands. Abnormalities in the kidneys can also cause diabetes insipidus. If the kidneys are abnormal, it can affect the way they process ADH.
Nephrogenic diabetes insipidus that's present at or shortly after birth usually has a genetic cause that permanently alters the kidneys' ability to concentrate the urine. Nephrogenic diabetes insipidus usually affects males, though women can pass the gene on to their children. ( Mayo Clinic Staff, 2015)
Pathophysiology of the Diabetes insipidus
Diabetes insipidus is caused by abnormality in the functioning or levels of antidiuretic hormone (ADH), also known of as vasopressin. Manufactured in the hypothalamus and stored in the pituitary gland, ADH helps to regulate the amount of fluid in the body.
In healthy individuals, when the bodily fluids are depleted, ADH is released from the pituitary gland which prevents the excretion of fluids from the body in the form of urine. ADH acts on the kidneys to increase water permeability in the collecting duct and distal convoluted tubule. Specifically, ADH acts on transmembrane protein channels called aquaporins that open up to allow water into the collecting duct. Once the permeability rises, the water is re-absorbed into the blood, reducing urine volume and increasing its concentration. The two forms of diabetes insipidus in central (cranial) diabetes insipidus, the production or release of ADH is too low to stop the kidneys from passing dilute urine, which results in an increased loss of water and therefore more thirst. People with nephrogenic diabetes insipidus, however, have adequate amounts of ADH in the body but the kidneys fail to respond it, and again the urine is still not concentrated.( News medical, 2015 )
Treatment
Fluid replacement
Most patients with diabetes insipidus (DI) can drink enough fluid to replace their urine losses. When oral intake is inadequate and hypernatremia is present, replace losses with dextrose and water or an intravenous (IV) fluid that is hypo-osmolar with respect to the patient’s serum. Do not administer sterile water without dextrose intravenously, as it can cause hemolysis. To avoid hyperglycemia, volume overload, and overly rapid correction of hypernatremia, fluid replacement should be provided at a rate no greater than 500-750 mL/h. A good rule of thumb is to reduce serum sodium by 0.5 mmol/L (0.5 mEq/L) every hour. The water deficit may be calculated on the basis of the assumption that body water is approximately 60% of body weight.
Desmopressin and other drugs
In patients with central DI, desmopressin is available in subcutaneous, IV, intranasal, and oral preparations. Generally, it can be administered 2-3 times per day.
Alternatives to desmopressin as pharmacologic therapy for DI include synthetic vasopressin and the nonhormonal agents chlorpropamide, carbamazepine, clofibrate (no longer on the US market), thiazides, and nonsteroidal anti-inflammatory drugs (NSAIDs). Because of side effects, carbamazepine is rarely used, being employed only when all other measures prove unsatisfactory. NSAIDs (eg, indomethacin) may be used in nephrogenic DI, but only when no better options exist. In central DI, the primary problem is a hormone deficiency; therefore, physiologic replacement with desmopressin is usually effective. Use a nonhormonal drug for central DI if response is incomplete or desmopressin is too expensive.
Monitoring
Monitor for fluid retention and hyponatremia during initial therapy. Follow the volume of water intake and the frequency and volume of urination, and inquire about thirst. Monitor serum sodium, 24-hour urinary volumes, and specific gravity. Request posthospitalization follow-up visits with the patient every 6-12 months. Patients with normal thirst mechanisms can usually self-regulate.
Dietary measures
No specific dietary considerations exist in chronic DI, but the patient should understand the importance of an adequate and balanced intake of salt and water. A low-protein, low-sodium diet can help to decrease urine output.(online from Medscape, 2014)
Nursing care ( Nursing Article , 2013 )
1. Fluid volume deficit related to excessive urinary output as manifested by increased thirst and weight loss.
Ø Assess the fluid level of the patient
Ø Monitor vital signs frequently
Ø Restrict oral fluid intake.
Ø Administer hypotonic saline intravenously.
Ø Administer medications if ordered.
2. Disturbed sleeping pattern, insomnia related to nocturia as manifested by verbalization of patient about interrupted sleep.
Ø Assess the sleeping pattern of the patient
Ø Give psychological support.
Ø Advice the patient to restrict oral fluids
Ø Provide calm and quiet environment.
3. Activity intolerance related to fatigue and frequent urination as manifested by fatigue and weakness of the patient.
Ø Assess the activity status of the patient
Ø Give psychological support to the patient.
4. Anxiety related to course of disease and frequent urination as manifested by verbalization of anxious questions.
Ø Assess the anxiety level of the patient.
Ø Explain the patient about the disease and treatment.
Ø Provide calm and quiet environment.
Ø Divert the attention of the patient by talking about different matter
5. Ineffective coping related to frequent urination as manifested by verbalization of negative feeling by the patient.
Ø Assess the coping ability of the patient
Ø Explain the patient about the disease and treatment
Ø Give psychological support.
Reference :
Chin J. ( 2014 ). Incidence and prevalence of the diabetes
Insipidus in Denmark. Retrieve May 7, 2015 from
http://www.ncbi.nlm.nih.gov/pubmed/24527719
Nursing Article. ( 2013 ).cause of Diabetes Insipidus. Retrieve May 7, 2015 from
http://studynursing.blogspot.com/2011/03/diabetes-insipidus.html
Nursingfile. (2010).Nursing care of the patient with Diabetes insipidus. Retrieved April 29,
2015 from http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-diabetes-insipidus.html
Mandal A. , (2013). Pathophysiology of the diabetes insipidus. Retrieved April
29, 2015 from
Pathophysiology.aspx" http://www.news-medical.net/health/Diabetes-Insipidus-
Pathophysiology.aspx
Mayo clinic. (2015). Risk factor of the diabetes. Retrieved April 29,2015 from
insipidushttp://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/basics/risk-
factors/con-20026841
Khardori R., George T. (2015). Incidence and prevalence of the diabetes
Insipidus inUnited state. Retreived April 28, 2015 from
http://emedicine.medscape.com/article/117648-overview#aw2aab6b2b2
Khardori R. ,George T . (2014). Treatment of the Diabetes insipidus. Retrieve April 29, 2015 from
http://emedicine.medscape.com/article/117648-treatment
Diabetes insipidusDiabetes insipidus is an uncommon condition in which the kidneys are unable to prevent the excretion of water. ( Medlineplus,2015)Diabetes insipidus is affect to body makes a substance called antidiuretic hormone (ADH). It’s produced in a part of your brain called the hypothalamus and stored in your pituitary gland. It tells your kidneys to hold onto water, which makes your urine more concentrated. ( WebMD, 2015)Incidence and prevalence of the disease worldwide and in Thailand.1. In Thailand can not find report about Diabetes Insipidus.2. DI is uncommon in the United States, with a prevalence of 3 cases per 100,000 population. No significant sex-related differences in central or nephrogenic DI exist, with male and female prevalence being equal. Similarly, no significant differences in prevalence among ethnic groups have been found.With both central and nephrogenic DI, inherited causes account for approximately 1-2% of all cases. An incidence of about 1 in 20 million births for nephrogenic DI caused by AQP2 mutations has been cited. ( Medscape , 2015 )3. The period prevalence rate of CDI in Denmark over the 5-year period investigated was 23 CDI patients per 100 000 inhabitants, with a higher prevalence in children and older adults (>80 years of age). The 1-year period prevalence rate of CDI decreased in Denmark over the 5 years from approximately 10 to 7 CDI patients per 100 000 inhabitants. The yearly incidence rate of new cases of CDI was found to be 3 to 4 patients per 100 000. The incidence of (presumable) congenital CDI was found to be 2 infants per 100 000 infants. Half of the patients with CDI prescribed as oral treatment were provided dosing instructions to only administer the drug before bedtime, and one third of the CDI patients either had no specific instructions or were instructed to use the drug as needed. Hospital admissions due to severe hyponatremia occurred in 0.9% of patients over a 5-year period, predominantly in females with an incidence ratio of women to men of 1.8:1. ( PubMed.ORG , 2013 )Risk factorDiabetes insipidus has several causes. In some people, a part of the brain (hypothalamus) doesn't make enough antidiuretic hormone (ADH). ADH helps your body balance water in the urine and blood. In other cases, the pituitary gland doesn't release enough of the hormone. Damage to either the hypothalamus or the pituitary gland can cause diabetes insipidus.This can occur after a head injury, during brain surgery or when a tumor grows on the glands. Abnormalities in the kidneys can also cause diabetes insipidus. If the kidneys are abnormal, it can affect the way they process ADH.Nephrogenic diabetes insipidus that's present at or shortly after birth usually has a genetic cause that permanently alters the kidneys' ability to concentrate the urine. Nephrogenic diabetes insipidus usually affects males, though women can pass the gene on to their children. ( Mayo Clinic Staff, 2015)Pathophysiology of the Diabetes insipidusDiabetes insipidus is caused by abnormality in the functioning or levels of antidiuretic hormone (ADH), also known of as vasopressin. Manufactured in the hypothalamus and stored in the pituitary gland, ADH helps to regulate the amount of fluid in the body.In healthy individuals, when the bodily fluids are depleted, ADH is released from the pituitary gland which prevents the excretion of fluids from the body in the form of urine. ADH acts on the kidneys to increase water permeability in the collecting duct and distal convoluted tubule. Specifically, ADH acts on transmembrane protein channels called aquaporins that open up to allow water into the collecting duct. Once the permeability rises, the water is re-absorbed into the blood, reducing urine volume and increasing its concentration. The two forms of diabetes insipidus in central (cranial) diabetes insipidus, the production or release of ADH is too low to stop the kidneys from passing dilute urine, which results in an increased loss of water and therefore more thirst. People with nephrogenic diabetes insipidus, however, have adequate amounts of ADH in the body but the kidneys fail to respond it, and again the urine is still not concentrated.( News medical, 2015 )TreatmentFluid replacementMost patients with diabetes insipidus (DI) can drink enough fluid to replace their urine losses. When oral intake is inadequate and hypernatremia is present, replace losses with dextrose and water or an intravenous (IV) fluid that is hypo-osmolar with respect to the patient’s serum. Do not administer sterile water without dextrose intravenously, as it can cause hemolysis. To avoid hyperglycemia, volume overload, and overly rapid correction of hypernatremia, fluid replacement should be provided at a rate no greater than 500-750 mL/h. A good rule of thumb is to reduce serum sodium by 0.5 mmol/L (0.5 mEq/L) every hour. The water deficit may be calculated on the basis of the assumption that body water is approximately 60% of body weight.Desmopressin and other drugsIn patients with central DI, desmopressin is available in subcutaneous, IV, intranasal, and oral preparations. Generally, it can be administered 2-3 times per day.Alternatives to desmopressin as pharmacologic therapy for DI include synthetic vasopressin and the nonhormonal agents chlorpropamide, carbamazepine, clofibrate (no longer on the US market), thiazides, and nonsteroidal anti-inflammatory drugs (NSAIDs). Because of side effects, carbamazepine is rarely used, being employed only when all other measures prove unsatisfactory. NSAIDs (eg, indomethacin) may be used in nephrogenic DI, but only when no better options exist. In central DI, the primary problem is a hormone deficiency; therefore, physiologic replacement with desmopressin is usually effective. Use a nonhormonal drug for central DI if response is incomplete or desmopressin is too expensive.Monitoring Monitor for fluid retention and hyponatremia during initial therapy. Follow the volume of water intake and the frequency and volume of urination, and inquire about thirst. Monitor serum sodium, 24-hour urinary volumes, and specific gravity. Request posthospitalization follow-up visits with the patient every 6-12 months. Patients with normal thirst mechanisms can usually self-regulate.Dietary measuresNo specific dietary considerations exist in chronic DI, but the patient should understand the importance of an adequate and balanced intake of salt and water. A low-protein, low-sodium diet can help to decrease urine output.(online from Medscape, 2014)Nursing care ( Nursing Article , 2013 )
1. Fluid volume deficit related to excessive urinary output as manifested by increased thirst and weight loss.
Ø Assess the fluid level of the patient
Ø Monitor vital signs frequently
Ø Restrict oral fluid intake.
Ø Administer hypotonic saline intravenously.
Ø Administer medications if ordered.
2. Disturbed sleeping pattern, insomnia related to nocturia as manifested by verbalization of patient about interrupted sleep.
Ø Assess the sleeping pattern of the patient
Ø Give psychological support.
Ø Advice the patient to restrict oral fluids
Ø Provide calm and quiet environment.
3. Activity intolerance related to fatigue and frequent urination as manifested by fatigue and weakness of the patient.
Ø Assess the activity status of the patient
Ø Give psychological support to the patient.
4. Anxiety related to course of disease and frequent urination as manifested by verbalization of anxious questions.
Ø Assess the anxiety level of the patient.
Ø Explain the patient about the disease and treatment.
Ø Provide calm and quiet environment.
Ø Divert the attention of the patient by talking about different matter
5. Ineffective coping related to frequent urination as manifested by verbalization of negative feeling by the patient.
Ø Assess the coping ability of the patient
Ø Explain the patient about the disease and treatment
Ø Give psychological support.
Reference :
Chin J. ( 2014 ). Incidence and prevalence of the diabetes
Insipidus in Denmark. Retrieve May 7, 2015 from
http://www.ncbi.nlm.nih.gov/pubmed/24527719
Nursing Article. ( 2013 ).cause of Diabetes Insipidus. Retrieve May 7, 2015 from
http://studynursing.blogspot.com/2011/03/diabetes-insipidus.html
Nursingfile. (2010).Nursing care of the patient with Diabetes insipidus. Retrieved April 29,
2015 from http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-diabetes-insipidus.html
Mandal A. , (2013). Pathophysiology of the diabetes insipidus. Retrieved April
29, 2015 from
Pathophysiology.aspx" http://www.news-medical.net/health/Diabetes-Insipidus-
Pathophysiology.aspx
Mayo clinic. (2015). Risk factor of the diabetes. Retrieved April 29,2015 from
insipidushttp://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/basics/risk-
factors/con-20026841
Khardori R., George T. (2015). Incidence and prevalence of the diabetes
Insipidus inUnited state. Retreived April 28, 2015 from
http://emedicine.medscape.com/article/117648-overview#aw2aab6b2b2
Khardori R. ,George T . (2014). Treatment of the Diabetes insipidus. Retrieve April 29, 2015 from
http://emedicine.medscape.com/article/117648-treatment
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