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What can trigger Diabetes Insipidus?
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Head trauma (most common cause is motor vehicle accidents), tumors, or infections in the area of the hypothalamus
Diabetes insipidus is a disorder of the _________, resulting from a deficiency in the secretion of ADH.
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Posterior pituitary gland
In diabetes insipidus, sodium is _________ in the serum, and body fluid is __________. (Increased or decreased)
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Sodium becomes concentrated in the serum, water is excreted rapidly resulting in an overall decrease/loss
What are the signs and symptoms of diabetes insipidus in the pediatric population?
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Increased urination (polyuria), excessive thirst (Polydipsia), hypernatremia, nocturia/enuresis (often a first sign), dehydration, weight loss. Possibly intermittent fevers, vomiting and/or constipation. * In infants, an early sign is irritability that is relieved with water, but not breastmilk or formula
How is diabetes insipidus typically treated?
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Daily replacement of ADH in the form of desmopressin. It can be given orally, nasally or subcutaneously every 8-12 hours
How is nephrogenic diabetes insipidus treated?
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Diuretics, high fluid intake, restricted sodium/high protein diet
How is nephrogenic diabetes insipidus different than diabetes insipidus?
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It is transmitted genetically as opposed to being the result of injury or tumors, it has nothing to do with the pituitary gland. The body has a vasopression (ADH) insensitivity at the level of the kidneys
T/F The onset of diabetes insipudus, like most other endocrine disorders, has a gradual onset and can be easily overlooked for some time.
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False, typically the onset is abrupt
What urinalysis findings would you expect in a child with untreated diabetes insipidus? Urine specific gravity: Urine osmolarity:
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Urine specific gravity: less than 1.005 Urine osmolarity: less than 3000 mOsm/L (dilute urine)
How is diabetes insipidus diagnosed?
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A fluid deprivation test is performed. If urine output and specific gravity don't increase and there's no change in serum sodium (i.e. it lowers), then the child has DI.
What is the goal of nursing treatment of child with DI?
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To achieve hourly output of urine at a rate of 1-2 ml/kg/hr and a urine specific gravity of at least 1.010
What needs to be monitored closely when administering vasopression/DDAVP?
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Blood pressure
When caring for a child with diabetes insipidus, the physician should be notified if urine output is greater than ________ mL per hour for two consecutive voids.
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1000 mL
What should you do if a child sneezes immediately after you've administered an intranasal dose of DDAVP?
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readminister it
What is the preferred method of storage for DDAVP?
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In the refrigerator at all times
Vasopression is administered to the pediatric population in doses than range from 25-300 ______. (grams, milligrams or micrograms)
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A child is brought into the clinic for evaluation. The mom states the child constantly complains of thirst and has been wetting the bed frequently even though she has been limiting his water close to bedtime. You automatically suspect...
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Diabetes insipidus (in this scenario, probably nephrogenic since there's no mention of trauma). Often the first signs are thirst coupled with bedwetting
_______ occurs when ADH is secreted despite low serum sodium resulting in water retention, continued low serum sodium, and extracellular fluid expansion.
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What conditions/events have been implicated in the development of SIADH?
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Meningitis, head trauma, brain tumors, intracranial sugery, use of analgesics, chemotherapies, or barbituates, or as a result of vasopression treatment of DI
What are the signs/symptoms associate with SIADH?
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Decreased urine output, increased urine specific gravity, fluid retention, weight gain, hyponatremia, increased urine osmolality, hypotonicity.
What are the usual treatments for pediatric SIADH?
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Fluid restrictions, IV sodium chloride to correct hyponatremia and to correct low serum osmolality
In a child with SIADH, what system changes are indicative of hyponatremia?
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Neurological changes like lethargy, behavioral changes, altered LOC, seizure, coma.
What nursing interventions can help a child with SIADH cope with fluid restrictions?
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Offer sugarless candy, a wet washcloth or ice chips
What are the general areas of nursing management related to care of a pediatric patient with SIADH?
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Strict I & O, daily weight, observing for signs of fluid overload, seizure precautions due to hyponatremia & fluid restriction

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