Remember ADH is released as serum osmolality ⬆️ to ⬆️ renal water reabsorption, but in patients with DI this doesn’t occur and so they pass large vol watery urine - can be >10L/day!🛁
So this weekend you heard from our friends @BukuRenal that mismanagement of IV fluids can cause harm.
A group we’d like to highlight who can come to serious harm from ⬆️/⬇️ fluids is patients with
💦DIABETES INSIPIDUS 💦
See below 👇
#medtwitter #FOAMed
Remember ADH is released as serum osmolality ⬆️ to ⬆️ renal water reabsorption, but in patients with DI this doesn’t occur and so they pass large vol watery urine - can be >10L/day!🛁
Misunderstandings are so common (even with HCPs) that there is a campaign to change the name to "pituitary insipidus"
#NoTimeToDI
Pituitary adenomas themselves can cause lots of hormone dysfunction, but don't typically cause DI.
- renal disease
- electrolytes (⬇️ K, ⬆️ Ca – hence why hyperCa is dehydrating)
- drugs - can be seen with up to 15% of people taking LITHIUM 💊
They may have multiple other hormone deficiencies (e.g. cortisol, thyroid, sex hormones, growth hormone).
Adding synthetic ADH (desmopressin) – nasal spray or tablet – also helps by ⬇️ UO and so ⬇️polyuria/nocturia when given at🌛 - can be very important for QOL!
– ⬆️ fluid losses (e.g. fever, vomiting)
- ⬇️access to meds and/or fluids (esp if confused, drowsy, NBM etc)
= profound dehydration and ⬆️⬆️ Na despite “reassuring” UO
Sadly this has led to several deaths.
1.RECOGNISE DI – from PMHx, drug hx, medic alert, electronic record alert and SHARE INFO WITH TEAM 📢
-> rare condition often = ⬇️ awareness
2.Give usual desmo - 🔔CRITICAL MED🔔
3.Alert endo team 📞
4.Monitor – Na AT LEAST DAILY, fluid in/out
1.Consider ⬆️ level care and d/w specialist asap
2.Give desmo – can be given IV/IM (get help w conversion!) if usual routes not available 💉
3.Aim to bring down Na SLOWLY with fluids (<10mmol/24h)
5.👀 Na e.g. 4hrly, fluid in/out..
- those taking Desmopressin will struggle to excrete excesses if given too much fluid
- d/w specialist - may require Desmopressin dose change or delay to allow for controlled diuresis
Allow pt to take fluid orally (v IV) if possible so can self-regulate 👍
Did you know the Society for Endocrinology has published advice about DI for non-specialists?
You can find that here 👇
https://t.co/kHjDRH7G4G
More from Health
Some thoughts on this: Firstly, it might be personal preference, but I am not keen on this kind of campaign as I feel like it trivialises cancer. Sometimes the serious message gets lost because people are sharing pics of cats or whatever and the important context is gone.
More importantly, the statistic being used in the campaign is misleading. It says 57% of women put off cervical screening if they can't get waxed. But on further investigation, that's not accurate.
The page here goes on to say "57% of women who regularly have their pubic hair professionally removed would put off attending their cervical screening appointment if they hadn’t been able to visit a beauty salon."
So the 57% represents a concern not across the whole population of women, but only those who regularly get waxed. So how big of an issue is this across the whole population? And what else is stopping people getting smears?
I think campaigns for cancer screening are really tricky because there is so much nuance that often doesn't fit into a catchy headline or hashtag. It's certainly not easy and is part of a bigger conversation.
It\u2019s #CervicalCancerPreventionWeek \U0001f499
— myGP (@myGPapp) January 18, 2021
Here\u2019s how you can help to raise awareness:
\U0001f431 Share an image of the cat that best reflects your undercarriage/flower/bits (technical term vulva!) current look.
#\u20e3Use the Hashtag #myCat.
\U0001f46dTell and tag your friends to let them know. pic.twitter.com/8aHf96ynjT
More importantly, the statistic being used in the campaign is misleading. It says 57% of women put off cervical screening if they can't get waxed. But on further investigation, that's not accurate.
The page here goes on to say "57% of women who regularly have their pubic hair professionally removed would put off attending their cervical screening appointment if they hadn’t been able to visit a beauty salon."
So the 57% represents a concern not across the whole population of women, but only those who regularly get waxed. So how big of an issue is this across the whole population? And what else is stopping people getting smears?
I think campaigns for cancer screening are really tricky because there is so much nuance that often doesn't fit into a catchy headline or hashtag. It's certainly not easy and is part of a bigger conversation.