RESPONSE 1:
2. Describe the pathophysiology, clinical manifestations, evaluation, and treatment of two diseases of the posterior pituitarysyndrome of inappropriate antidiuretic hormone secretion (SIADH) and diabetes insipidus (DI).
Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH)
The pathology of SIADH is water retention from action of ADH on renal collecting ducts, where it increases their permeability to water, thus increasing water reabsorption by the kidneys (McCance & Huether, 2014). What this results in is the expansion of extracellular fluid volume that leads to dilutional hyponatremia, hypoosmolarity, and urine that is inappropriately concentrated with respect to serum osmolarity (McCance & Huether, 2014).
Clinical Manifestations
The signs and symptoms depend on rate and severity of hyponatremia and the degree of cerebral edema. Acute hyponatremia sign and symptoms include, nausea and malaise (Yasir & Mechanic, 2021). With a more severe and acute fall in sodium concentration, headache, lethargy, obtundation, and eventually, seizures can occur (Yasir & Mechanic, 2021). When sodium concentration in the body reaches critical levels of 115-120 meq/L then coma or respiratory arrest can occur (Yasir & Mechanic, 2021).
Evaluation
The Schwartz and Bartter Clinical Criterion can determine if SIADH is present with these inclusions: Serum sodium less than 135mEq/L, serum osmolality less than 275 mOsm/kg, urine sodium greater than 40 mEq/L, urine osmolality greater than 100 mOsm/kg, the absence of clinical evidence of volume depletion, correction of hyponatremia by fluid restriction, and absence of other causes of hyponatremia such as medications that affect renal water excretion (Yasir & Mechanic, 2021).
Treatment
Treatment of SIADH involves the correction of the underlying causal problems; emergency correction of severe hyponatremia by administration of hypertonic saline; and, most importantly, fluid restriction to 800 to 1000 ml/day (McCance & Huether, 2014). It is important to correct the hyponatremia slowly, if sodium correction is too rapid a severe neurologic syndrome called central pontine myelinolysis can ensue (McCance & Huether, 2014).
Diabetes Insipidus (DI)
DI is the insufficiency of antidiuretic hormone (ADH) so you will have polyuria, and polydipsia. There are 3 forms of DI: Neurogenic (Hypothalamus), Nephrogenic (Renal), and Dipsogenic (polydipsia-polyuria syndrome) (McCance & Huether, 2014). All of the 3 forms of DI are characterized by the inability of the kidney to increase permeability to water. This causes excretion of large volumes of dilute urine and an increase in plasma osmolality (McCance & Huether, 2014).
Clinical Manifestations
Most prominent symptoms are polyuria and polydipsia. Polyuria is defined as a urine output of more than 3 L/day in adults or 2 L/m2 in children (Hui, Khan, & Radbel, 2021). Children may present symptoms as severe dehydration, constipation, weakness and lethargy (Hui, Khan, & Radbel, 2021). Other signs and symptoms include visual defects, headaches, myalgia, and extreme thirst (Hui, Khan, & Radbel, 2021).
Evaluation
Evaluation of DI we calculate plasma osmolality, calculate 24 hour urine volume, assess lab electrolytes, and perform a water deprivation test with DDAVP to differentiate central and nephrogenic diabetes insipidus (Hui, Khan, & Radbel, 2021).
Treatment
Treatment for neurogenic DI is based on the extent of the ADH deficiency and on individual variables such as age, endocrine and cardiovascular status, and lifestyle (McCance & Huether, 2014). For symptomatic neurogenic DI patients, DDAVP can be given intranasally or orally (McCance & Huether, 2014). For nephrogenic DI patients this requires treatment of any reversible underlying disorders, discontinuation of etiologic medications, and correction of associated electrolyte disorders (McCance & Huether, 2014).
RESPONSE 2:
#1 Hyperglycemia
Diabetes is a chronic illness that affects many people, yet many don’t understand how it does and how to manage it. In my practice, I see patients with hyperglycemia and with ketoacidosis from poorly controlled diabetes. All patients come from different walks of life. Yesterday alone, I had two other patients that came through the emergency department complaining of abdominal pain, weakness, headache, frequent urination, nausea, and vomiting. One patient is homeless, and the other is firmly middle class. Both patients had blood sugars of well over 500 mg/dL.
The long-term effects of an illness can lead to many complications or additional health problems. This is true as well when it comes to diabetes. A system of our body affected by continuously elevated blood sugars is our cardiovascular system, increasing blood pressure, which could also affect the kidneys and heart disease. People with uncontrolled diabetes can have eye problems, weakened immune systems, nerve problems like neuropathy. Neuropathy can lead to loss of sensation of extremities like feet, leading to an unnoticed injury that can eventually get infected and cause sepsis (Wisse, 2021).
According to Delamater, adherence to diabetes treatment and regiment can be affected by different factors, from socioeconomic, education, beliefs, and motivation (2006). Some patients do not adhere to their treatment regimen because they are unaware of their illness’s severity. To fix this issue, healthcare providers must evaluate each patients perception of the seriousness of the disease. Make sure that patients understand what happens when they dont manage their diabetes. Family education is necessary because patients with no help from family tend to become nonadherent. As a provider, I will create a treatment plan with the patient, so I am working with the patient and not dictating to the patient (Delamater, 2006).
