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
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"I really want to break into Product Management"
make products.
"If only someone would tell me how I can get a startup to notice me."
Make Products.
"I guess it's impossible and I'll never break into the industry."
MAKE PRODUCTS.
Courtesy of @edbrisson's wonderful thread on breaking into comics – https://t.co/TgNblNSCBj – here is why the same applies to Product Management, too.
There is no better way of learning the craft of product, or proving your potential to employers, than just doing it.
You do not need anybody's permission. We don't have diplomas, nor doctorates. We can barely agree on a single standard of what a Product Manager is supposed to do.
But – there is at least one blindingly obvious industry consensus – a Product Manager makes Products.
And they don't need to be kept at the exact right temperature, given endless resource, or carefully protected in order to do this.
They find their own way.
make products.
"If only someone would tell me how I can get a startup to notice me."
Make Products.
"I guess it's impossible and I'll never break into the industry."
MAKE PRODUCTS.
Courtesy of @edbrisson's wonderful thread on breaking into comics – https://t.co/TgNblNSCBj – here is why the same applies to Product Management, too.
"I really want to break into comics"
— Ed Brisson (@edbrisson) December 4, 2018
make comics.
"If only someone would tell me how I can get an editor to notice me."
Make Comics.
"I guess it's impossible and I'll never break into the industry."
MAKE COMICS.
There is no better way of learning the craft of product, or proving your potential to employers, than just doing it.
You do not need anybody's permission. We don't have diplomas, nor doctorates. We can barely agree on a single standard of what a Product Manager is supposed to do.
But – there is at least one blindingly obvious industry consensus – a Product Manager makes Products.
And they don't need to be kept at the exact right temperature, given endless resource, or carefully protected in order to do this.
They find their own way.