Types of Diabetes Insipidus Disease with Causes and Nursing Intervention

Definition of Diabetes Insipidus Disease:

Diabetes insipidus disease refers to hyposecretion of ADH (Antidiuretic Hormone) or decreases the ability to concentrate urine because of resistance to ADH action in the Kidney. It is characterized by excessive thirst despite the drinking of fluids and excretion of large amounts of severely dilute urine, diabetes insipidus is an uncommon disorder.

Types of Diabetes Insipidus Disease:

There are four types of diabetes insipidus:

1. Central Diabetes Insipidus Disease:

Central diabetes insipidus results from the lack of vasopressin production in the hypothalamus or the pituitary gland. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders.

2. Nephrogenic Diabetes Insipidus Disease:

Nephrogenic diabetes insipidus happens when the kidney unable to respond normally to vasopressin. The kidneys’ response-ability is impaired to ADH by drugs-like lithium, polycystic kidney disease, sick cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders.

3. Dipsogenic Diabetes Insipidus Disease:

Dipsogenic diabetes insipidus is caused by an abnormal increase of thirst and fluid intake that suppresses ADH secretion and increases urine output.

4. Gestational Diabetes Insipidus Disease:

Gestational diabetes insipidus occurs only during pregnancy, women produce vasopressinase in the placenta, which breaks down ADH.

Diabetes insipidus should not be confused with diabetes mellitus (DM), which results from insulin deficiency or insulin resistance to blood glucose. Diabetes insipidus and diabetes mellitus are different, although they have the same signs and symptoms.

Etiology:

1. Loss of ADH production,
2. Nephrogenic (Lack of renal response to ADH),
3. Surgery or tumor of the pituitary gland,
4. Metastatic neoplasm of the pituitary gland,
5. Head injury,
6. Meningitis,
7. Encephalitis,
8. Heredity,
9. High level of calcium in the body (Hypercalcemia),
10. Kidney disease (Such as polycystic kidney disease),
11. Certain drug use – Lithium and Demeclocycline.

The manifestation of Diabetes Insipidus Disease:

Different types of manifestation of diabetes insipidus are mentioned in the following:

1. Polyurea (Hourly urine output > 200mls),
2. Polydipsia (increased thirst),
3. Nocturia and sleep disturbance,
4. Weight and energy loss,
5. Irritability,
6. Unusually wet diapers,
7. Excessive fatigue,
8. Muscle pain,
9. Headache,
10. Hair loss,
11. Dry skin with cool extremities/dehydration,
12. Diminished libido or erectile dysfunction,
13. Delay growth,
14. Serum hyperosmolality and hypernatremia ,
15. Tachycardia and hypotension.

Diagnosis and Test for Diabetes Insipidus Disease:

Various types of diagnostic and test for diabetes insipidus disease are below:

1. Water deprivation test (WDT),
2. ADH stimulation test,
3. Urinalysis,
4. A 24-hour urine collection for determination of urine volume,
5. Urinary specific gravity test,
6. Serum electrolytes concentration,
7. Glucose level,
8. Kidney function studies,
9. Pituitary studies,
10. MRI of the brain,
11. Genetic screening,
12. Blood sodium and Osmolarity,
13. Desmopressin (DDAVP) challenge,
14. Radioimmunoassay to measure circulating ADH concentrations.

A complication of Diabetes Insipidus Disease:

There are different types of complication for diabetese insipidus disease, which are the following:

1. Dry mouth and lips,
2. Sunken features (particularly the eyes),
3. Headaches,
4. Dizziness,
5. Confusion and irritability.

Management and Treatment for Diabetes Insipidus Disease:

Various types of management and treatment for diabetese insipidus disease are mentioned below:

1. Drink enough fluid to replace urine losses.
2. If oral intake inadequate and hypernatremia present.

• Infused dextrose or sterile water intravenously that is hypo-osmolar concerning the patient serum.
• Administer fluid at a rate of 500-750 ml/ hour to reduce the sodium level by approximately .5mmol/L per hour.

3. Desmopressin acetate (DDAVP) can be administered orally, intravenously, or as nasal spray.
4. Synthetic vasopressinor Aqueous vasopressin( pitressin)or Vasopressin tenant.
5. Hydrochlorothiazide+ low-sodium diet to induce mild sodium depletion.
6. Chlropropamide.
7. Carbamazepine.
8. Clofibrate.
9. The nonsteroidal anti-inflammatory drug when no better option exists.
10. Indomethacin may also be useful to reduce urine volume.

Nursing Intervention for Diabetes Insipidus Disease:

There are different types of nursing intervention for diabetes insipidus disease, which are mentioned in the following:

1. Maintain fluid and electrolytes imbalance by appropriate fluid replacement therapy strictly administer hypotonic saline intravenously.
2. Monitor intake output chart hourly.
3. Monitor weight charts daily using the same scales at the same time and wearing the same clothing.
4. Monitor specific gravity of urine.
5. Monitor serum and urine osmolality.
6. Monitor serum electrolytes and blood urea levels.
7. Monitor for signs of hypovolemic shock (e.g., Tachycardia, Tachypnea, and Hypotension).
8. Monitor vital signs frequently.
9. Monitor skin turgor and neurologic status every 1-2 hours during the acute phase.
10. Ensure safety precautions if patients complain of dizziness or weakness.
11. Ensure easy access to bathroom, bedpan, or urinal when patient need.
12. Provide careful skin and mouth care to prevent trauma.
13. Give vasopressin with caution if the patient has coronary artery disease.
14. Encourage the patient to maintain adequate fluid intake to prevent severe dehydration.
15. Allow the patient to drink water at will.
16. Monitor for increased thirst (polydipsia).
17. Use skin barriers as needed to prevent redness or excoriation from urinary frequency.
18. Provide rest and assess the sleeping pattern of the patient.
19. Provide a calm and quiet environment and give psychological support.
20. Assess the anxiety level of the patient and explain the patient about the disease and treatment process.

More questions related to this topic:

1. Why is Diabetes Insipidus Called Diabetes?
2. Can Diabetes Insipidus Cause Kidney Failure?
3. What is Diabetes?
4. Diabetes Insipidus: An Overview
5. Diabetes Insipidus: Get the Facts on Treatment and Symptoms.
6. Diabetes Insipidus Symptoms, Causes, and Treatment.
7. How Do You Treat Diabetes Insipidus?
8. What is Diabetes Insipidus?
9. What is the Meaning of Diabetes Insipidus?
10. What is the Meaning of Insipidus?
11. Diabetes Insipidus Definition.
12. What are the Types of Diabetes Insipidus?
13. Diabetes Insipidus Diagnosis.
14. Diabetes Insipidus Treatment.

Maria Mona

Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “maria.mona023@gmail.com”