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