1. Diabetes Insipidus (DI)

2. The disorder of posterior lode of pituitary gland
A deficiency of ADH (Vsaopressin) result in inability to conserve Water.
Polydipsia
Large volume of diluted urine

3. DI idiopathic in all about 30% of all clients with DI
INCIDENCE
DI idiopathic in all about 30% of all clients with DI
Tumors can be related to 25% of DI cases
Head Injury accounts 16%
cranial Surgery for 20% of cases

4. Central or neurogenic DI –
Etiology
Central or neurogenic DI –
CNS interruption of anatomic integrity of posterior pituitary
Localize Edema
Head trauma
Central acting drugs or
CNS infection

5. Rare hereditary disorder
Complete DI
Occurs when there is disruptions of hypophyseal tract and a complete absence of ADH
Neurogenic DI
Rare hereditary disorder
Acquire structural or functional change in kidney occurs; ADH produce normal but Distal and collecting tubules cannot responds

6. Drugs that inhibit vasopressin Release:
Risk Factors
Head injury
Neurosurgery
Hypothalamic tumors
Pituitary tumor
Brain infection
Brain Inflammation
Drugs that inhibit vasopressin Release:
Ethanol, Glucocorticoids, Adrenergic Agents, Lithium

7. CLINICAL MANIFESTATIONS
Polydipsia
Large volume of dilated urine.
Integumentary – Dry, cool skin, Dry mucus membrane
CV- Tachycardia, hypotension
GU- Polyuria- a Few liters to 18L/Day , Clear urine, Urinary frequency
Neurologic – Mentation changes as electrolyte imbalance

8. Blood test- serum level of ADH
Diagnosis finding
History
Physical examination
Blood test- serum level of ADH
Urine output- a few liter to 18 liter, Specific gravity decrease, Osmolality <200 MOSm/Kg H2o, 3-5% body weight lost
Plasma osmolality increase
Serum Na decrease

9. ADH Replacement (Desmopresin)
MEDICAL MANAGEMENT
Iv fluids
ADH Replacement (Desmopresin)
Clofibrate (hypolipidemic agent, antidiuretic effect
Thiazide diuretics, prostaglandin inhibitors
Surgical MGT Hypophysectomy to removal of posterior pituitary tumor

10. Monitor for excessive thirst or urination Assess serum and urine value
Nursing Management
Monitor Intake Output
Monitor for excessive thirst or urination
Assess serum and urine value
Client and family teaching

11. Complications Electrolyte Imbalance Hypovolemia Hypotension Shock