 Hi and welcome to Nursing School explain this video on diabetes in syphidis that is sometimes also referred to as water diabetes. Now keeping in mind it has nothing to do with diabetes type one or two it's just another disorder that affects the kidneys. In order to really understand how this mechanism of altered ADH or interdiabetic hormone works let's review the path of physiology or the physiology of how ADH usually works in our bodies. So we have the hypothalamus that then stimulates the pituitary gland that is divided into the anterior and posterior part and from the posterior pituitary gland under normal conditions in response to low blood pressure or increased serum osmolarity ADH interdiabetic hormone is secreted. It then stimulates the kidney to increase the reabsorption of sodium and water and if we have more water in our system it will bring up the blood pressure. Now that is the normal mechanism of how ADH is supposed to work. Now if we have too much ADH secretion then we have syndrome of inappropriate ADH but if we have too little ADH then we are dealing with diabetes and syphidis which is what we're going to look at in detail here. So for causes that can be basically two different things that are happening. So that can either be decreased ADH production by the pituitary gland that can usually be because of a brain tumor head injury any kind of central nervous system infection as well as brain surgery or it can be a decreased real response to ADH and that is usually due to renal damage that can be due to renal conditions such as pilonephritis or any kind of obstruction of the urinary system but it can also be due to nephrotoxic drugs and lithium is a specifically damaging medication to the kidneys that can lead to diabetes and syphidis and then also what are called psychogenic causes of diabetes and syphidis which would be increased or crazy amounts of intake of water which can be psychological disorders as well as any kind of thirst center disorders and therefore the patient will just drink drink drink drink drink water and then everything will be diluted in their system. So signs of symptoms of any of these causes of diabetes and syphidis will be polydipsia and polyuria and this can be a significant amount of urine that this patient is producing anywhere from 2 to 20 liters per day. Now if we're excreting that much urine it's going to be very dilute right we're going to be drinking a lot of water we're not really having all these electrolytes that are concentrated and then we're going to just basically excrete all that urine meaning that the specific gravity is going to be very low so less than 1.005. Now along with any of these disorders with ADHD we have to keep in mind that the goal really and the normal functioning would be sodium and water reabsorption and whenever sodium goes out of balance whether it's high or low keep in mind it always causes neurological symptoms and they may be as little or as mild as irritability or headache but they might lead to altered level of consciousness, seizures and maybe even coma if the sodium gets way out of balance. And then for diagnostic tests so if the patient presents with these symptoms usually the serum will be very concentrated because the patient is just excreting so much during that there's basically now fluid volume deficit in the patient's body evidenced by serum osmolarity greater than 295 so very concentrated as well as a serum sodium of gradient 145 which is typically the upper borderline and then again this urine specific gravity that is less than 1.005. So now we're losing a lot of water which means that the urine is going to be very dilute with very little particles in there but because we don't have any more of that volume of that water in the body it'll be very concentrated evidenced by the serum osmolarity and hypernatrium. And then there is a test called the water deprivation test so basically the patient won't be given any water for about eight or twelve hours and then they will be given adh a synthetic form of adh and if that leads to then decrease to an output an increased specific gravity so basically now we are responding to adh which is the normal response that means that the water deprivation test is going to be positive if we have cerebral causes so if there is a problem with the pituitary gland because now we're given the patient adh and everything takes its normal course and everything goes back to normal in terms of fluid and water balance but if there is no response to the adh that we're given that means that the cause of the problem is usually the kidney and then there are different treatments depending on what the cause is so the water deprivation test is a very good test here to see is it a cerebral cause from the pituitary gland or is the problem within the kidney as for treatment so if it's a cerebral cause then the patient is going to have to get fluid replacement remember they are just generating all the time they're losing a lot of water losing a lot of fluid so we'll have to replace that and that can be PO or IV with hypotonic saline or D5W and then it's usually titrated to given output so if they give an output um then it gets balanced out then we can decrease the fluid administration and then we can the treatment is administered DDAVP which is the synthetic form of adh and that can be given by various routes it can be given already IVs subcutaneously or nasal spray and typically once the diabetes umensipitis is under control but we know that it's a cerebral cause the patient most likely will have a nasal spray that they go home with um as a means of self-administering that adh that they are lacking so that they're not ending up in a crisis in a hypervolumic crisis but if the cause is the kidney so if now we've done the water deprivation test and there's no response to this um synthetic adh then the patient will have to go on a decreased or low sodium diet they will also have to be on fireside diuretics with potassium replacement because otherwise they're at risk for hypokalemia and if there's no response to that uh in the medicine sometimes helps as an onset sometimes helps to increase the real response to adh so now that all these other mechanisms can both go back and to be balanced and uh as for our nursing care remember when we're dealing with any kind of fluid volume problem we always want to monitor vital signs specifically heart rate as well as blood pressure daily weight and eyes and nose to check for fluid balance as well as normal checks because we know um diabetes insipidus can cause hypernatremia and we know that sodium levels can be or are very indicative of mental status changes so if the patient presents with very vague mental status changes um we always have to think about the sodium imbalance so neural checks will be very important to determine as well as checking the urine specific gravity to see if we're making any progress with any of these interventions that we have done here to see if the urine is now becoming more concentrated and that adh is actually working so thank you for watching this video on diabetes insipidus if you have not already done so please also watch the video of the opposite disorder with increased adh which is called siadh or any other videos in the endocrine playlist please subscribe to my channel give me a thumbs up if you like this video and i'll see you soon here on nursing school explain thanks for watching