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AG-ACNP Boards – endocrine Questions and Answers
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AG-ACNP Boards – endocrine Questions and Answers
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AG-ACNP Boards – endocrine Questionsand Answers
SIADH Correct Ans--Inappropriate Water RETENTION, release of ADH occurs independent
of osmolality or volume dependent stimulation
-2/2 paraneoplastic syndrome classically lung, CNS disorder, Chronic lung disease, pneumonia,
skull fx/head trauma
S/S of SIADH Correct Ans--Neurologic changes: mild H/A, seizures, coma (D/T
hyponatremia)
-Decreased DTRs
-hypothermia/cold intolerance
-weight gain/edema
-n/v
Lab/Diagnosis of SIADH Correct Ans-Hyponatremia: yet euvolemic
Decreased serum osmolality (<280)
,Increased urine osmolality (>100)
Urine Sodium >20
Renal, cardiac, thyroid function normal
SIADH urine sodium Correct Ans--Na+ handling is regulated by aldosterone - hypervolemia
= low aldosterone production = high Na excretion.
-the urine Na+ concentration reflects Na+ intake, which is generally more than 40 mEq/d
(usually 50-100 mEq/d)
SIADH treatment Correct Ans-*fluid restriction
*treatment of underlying disorder
*ADH receptor antagonist:
-Demeclocycline
-lithium
-vasopressin receptor antagonists
, SIADH fluid restriction guidelines Correct Ans-Mild (asymptomatic with sodium 120-130
meq/L) = 1000ml/24h Fl R
Moderate (asymptomatic with sodium 110-120 meq/L) = 500ml/24h Fl R
Severe (symptomatic) = Loop diuretic + normal saline 0.9% or hypertonic saline 3% saline
Diabetes Insipidus Correct Ans-*Central: Related to pituitary or hypothalamus damage
resulting in ADH deficiency
*Nephrogenic: due to defect in the renal tubules resulting in renal insensitivity to ADH.
-Acquired due to phelonephritis
-K+ depletion
-sickle cell anemia
-chronic hypercalcemia causing renal failure
-medications (lithium, demeclocycline)
S/S of DI Correct Ans--Fluid intake 5-20L/day
-polyuria 2-20L/day
-weight loss, fatigue, tachycardia, hypotension
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