DIABETES INSIPIDUS: Types of Diabetes Insipidus Disease with Causes and Nursing Intervention

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Definition of Diabetes Insipidus Disease:

Diabetes insipidus disease refers hyposecration of ADH (Antidiuretic Hormone) or decrease ability to concentrate urine because of resistance to ADH action in the Kidney. It is characterized by excessive thirst despite the drinking of fluids and excretion of large amounts of severely dilute urine, diabetes insipidus is an uncommon disorder.

Types of Diabetes Insipidus Disease:

There are four types of diabetes insipidus:

1. Central Diabetes Insipidus Disease:

Central diabetes insipidus, results from the lack of vasopressin production in the hypothalamus or the pituitary gland. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, nneurosurgery, or genetic disorders.

2. Nephrogenic Diabetes Insipidus Disease:

Nephrogenic diabetes insipidus happen when the kidney unable to respond normally to vasopressin. The kidneys’ respond ability impaired to ADH by drugs-like lithium, polycystic kidney disease, sick cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders.

3. Dipsogenic Diabetes Insipidus Disease:

Dipsogenic diabetes insipidus is caused by an abnormal increase of thirst and fluid intake that suppresses ADH secretion and increases urine output.

4. Gestational Diabetes Insipidus Disease:

Gestational diabetes insipidus occurs only during pregnancy, women produce vasopressinase in the placenta, which breaks down ADH.

Diabetes insipidus should not be confused with diabetes mellitus (DM), which results from insulin deficiency or insulin resistance to blood glucose. Diabetes insipidus and diabetes mellitus are different, although they have same signs and symptoms.

Etiology:

1. Loss of ADH production,
2. Neprogenic (Lack of renal response to ADH),
3. Surgery or tumour of pituitary gland,
4. Metastatic neoplasm of pituitary gland,
5. Head injury,
6. Meningitis,
7. Encephalitis,
8. Heredity,
9. High level of calcium in the body (Hypercalcemia),
10. Kidney disease (Such as polycystic kidney disease),
11. Certain drug use – Lithium and Demeclocyclin.

Manifestation of Diabetes Insipidus Disease:

Different types of manifestation of diabetes insipidus are mentioned in the following:

1. Polyurea (Hourly urine output > 200mls),
2. Polydipsia (Increased of thirst),
3. Nocturia and sleep disturbance,
4. Weight and energy loss,
5. Irritability,
6. Unusually wet diapers,
7. Excessive fatigue,
8. Muscle pain,
9. Headache,
10. Hair loss,
11. Dry skin with cool extremities/dehydration,
12. Diminished libido or erectile dysfunction,
13. Delay growth,
14. Serum hyperosmolality and hypernatremia ,
15. Tachycardia and hypotension.

Diagnosis and Test for Diabetes Insipidus Disease:

Various types of diagnostic and test for diabetes insipidus disease are in the below:

1. Water deprivation test (WDT),
2. ADH stimulation test,
3. Urinalysis,
4. A 24 hour urine collection for determination of urine volume,
5. Urinary specific gravity test,
6. Serum electrolytes concentration,
7. Glucose level,
8. Kidney function studies,
9. Pituitary studies,
10. MRI of brain,
11. Genetic screening,
12. Blood sodium and Osmolarity,
13. Desmopressin (DDAVP) challenge,
14. Radioimmunoassy to measure circulating ADH concentrations.

Complication of Diabetes Insipidus Disease:

There are different types of complication for diabetese insipidus disease, which are in the following:

1. Dry mouth and lips,
2. Sunken features (particularly the eyes),
3. Headaches,
4. Dizziness,
5. Confusion and irritability.

Management and Treatment for Diabetes Insipidus Disease:

Various types of management and treatment for diabetese insipidus disease are mentioned in the below:

1. Drink enough fluid to replace urine losses.
2. If oral intake inadequate and hypernatremia present.

• Infused dextrose or sterile water intravenously that is hypo-osmolar with respect to the patient serum.
• Administer fluid at a rate of 500-750 ml/ hour to reduce sodium level approximately .5mmol/L per hour.

3. Desmopressin acetate (DDAVP) can be administered orally, intravenously or as nasal spray.
4. Synthetic vasopressinor Aqueous vasopressin( pitressin)or Vasopressin tenate.
5. Hydrochlorothiazide+ low-sodium diet to induce mild sodium depletion.
6. Chlropropamide.
7. Carbamazepine.
8. Clofibrate.
9. Non steroidal anti-inflammatory drug when no better option exists.
10. Indomethacin may also be useful to reduce urine volume.

Nursing Intervention for Diabetes Insipidus Disease:

There are different types of nursing intervention for diabetes insipidus disease, which are mentioned in the following:

1. Maintain fluid and electrolytes imbalance by appropriate fluid replacement therapy strictly administer hypotonic saline intravenously.
2. Monitor intake output chart hourly.
3. Monitor weight chart daily using the same scales at the same time and wearing the same clothing.
4. Monitor specific gravity of urine.
5. Monitor serum and urine osmolality.
6. Monitor serum electrolytes and blood urea levels.
7. Monitor for signs of hypovolemic shock (e.g., Tachycardia, Tachypnea, and Hypotension).
8. Monitor vital signs frequently.
9. Monitor skin turgur and neurologic status every 1-2 hours during acute phase.
10. Ensure safety precautions if patient complain dizziness or weakness.
11. Ensure easy access of bathroom, bedpan or urinal when patient need.
12. Provide carefully skin and mouth care to prevent trauma.
13. Give vasopressin with caution if the patient has coronary artery disease.
14. Encourage patient to maintain adequate fluid intake to prevent severe dehydration.
15. Allow the patient to drink water at will.
16. Monitor for increased thirst (polydipsia).
17. Use skin barriers as needed to prevent redness or excoriation from urinary frequency.
18. Provide rest and assess the sleeping pattern of the patient.
19. Provide calm and quiet environment and give psychological support.
20. Assess the anxiety level of the patient and explain the patient about the disease and treatment process.

More questions related this topic:

1. Why is Diabetes Insipidus Called Diabetes?
2. Can Diabetes Insipidus Cause Kidney Failure?
3. What is Diabetes?
4. Diabetes Insipidus: An Overview
5. Diabetes Insipidus: Get the Facts on Treatment and Symptoms.
6. Diabetes Insipidus Symptoms, Causes, and Treatment.
7. How Do You Treat Diabetes Insipidus?
8. What is Diabetes Insipidus?
9. What is the Meaning of Diabetes Insipidus?
10. What is the Meaning of Insipidus?
11. Diabetes Insipidus Definition.
12. What are the Types of Diabetes Insipidus?
13. Diabetes Insipidus Diagnosis.
14. Diabetes Insipidus Treatment.