Central Neurogenic Diabetes Insipidus

Topics: Vasopressin, Pituitary gland, Hypothalamus Pages: 6 (692 words) Published: December 8, 2014
Central Neurogenic Diabetes Insipidus,
Syndrome of Inappropriate Secretion of
Antidiuretic Hormone, and Cerebral SaltWasting Syndrome in Traumatic Brain Injury
Trauma

Topic Description:
This article focuses on Central Neurogenic Diabetes Insipidus (CNDI), Syndrome of Inappropriate Secretion of Antidiuretic
Hormone (SIADH), and Cerebral Salt-Wasting Syndrome in
Traumatic Brain injury (CSWS). Comparison of lab results and treatments are reviewed.

Topic objectives:
At the end of this topic, the participant will be able to:
1. List the potential causes of CNDI, SIADH, CSWS on the
hospitalized adult.
2. Compare and contrast CNDI, SIADH, CSWS
3. Discuss the treatment & nursing management for
CNDI,SIADH and CSWS.


Traumatic Brain Injury (TBI ) in adults continues to be a major cause of death and disability in the United States.
An estimated 1.7 million persons in the United States will sustain TBI , - approximately 52, 000 will die of the injury
- 275,000 will be hospitalized
- and 1.4 million will be treated and released from ED
Older adults ( > 75 years) have the highest rates of TBI- related hospitalization and death Patients who survive the initial injury are likely to have secondary complications that can result in permanent disability.

Approximately 80,000 – 90,000 patients experience long term disability each year because of TBI
THE MOST COMMON CAUSES OF TBI
1. Falls - 35.2 %
2. Motor vehicular accident- 17.3%
3. Being struck by or against objects -16.5%
4. Sports – related injuries- 10%
5. Penetrating trauma- 21%

Table Comparison of central neurogenic, diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone, & cerebral salt-wasting syndrome. Feature

Cerebral
Syndrome of
Neurogenic
Inappropriate
Diabetes Insipidus secretion of
antidiuretic
hormone (ADH)

Cerebral of saltwasting
syndrome

Definition

Fluid imbalance due
to decreased
secretion of ADH in
the posterior lobe of
the pituitary glad or to
renal
unresponsiveness to
the release of ADH

Persistent production
or over production of
ADH resulting and a
volume-expanded
state

Renal loss of sodium
leading to true
hyponatremia &
volume-contracted
state in which the
kidneys don’t
reabsorb sodium

Cause

Hypotension, stress,
pain, anxiety & an
upright position
Trauma, surgery or
damage of the
hypothalamus

Head Trauma, brain
tumor, abscess,
subarachnoid,
hemorrhage,
hydrocephalus,
meningitis,
encephalitis, GuillainBarre, pneumonia,
Drugs assoc. w/
increased secretion
(oral hypoglycemic
agents, non steroidal
& anti-inflammatories,
opiates, anesthetics)

Cause unclear but
often occurs in pt.’s
w/
Intracranial
abnormalities ( Head
Trauma, stroke, SAH,
brain tumors)

Summary
Managing and caring for patients with complex neurological problems , specifically patients with TBI & electrolyte imbalance, can be confounding. Understanding and recognizing the signs & symptoms of CNDI, SIADH, & CSWS will guide nurses the correct actions to take in order to avoid further deterioration in patient’s condition. Furthermore, monitoring patients for trends in neurological status, laboratory results and physiological parameters will guide nurses in determining whether treatment and management is effective or not.

Questions:
1. Which of the following groups is at greatest risk of death from a traumatic brain injury (TBI)?
a. Young children (0-4 years old)
b. Adolescents (15-19 years old)
c. Young adults ( 20-27 years old)
d. Older adults ( older than 75 years)
2. Which of the following is the most common cause of TBI?
e. Falls
c. Sports- related injuries
f. Motor vehicular crashes
d. Penetrating trauma
3. Where is antidiuretic hormone (ADH) stored in the body?
g. Infundibulum
c. Posterior pituitary gland
b. Hypothalamus
d. Kidney

Answers:
1. d
2. a
3. b

References:


Cynthia ( Cindi) A. John, RN,MSN,CNRN and Michael W. Day, RN,MSN,...

References: Practice of Neurological and Neurosurgical Nursing 6 th Ed. Philadelphia, PA. Wolters
Kluwer Health/Lippincott Williams & Wilkins, 2009:195-205
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