PEDIATRIC NURSING

1. DIABETES INSIPIDUS

2. Diabetes insipidus
 Diabetes insipidus is a disorder of the
posterior pituitary gland
 Inability of the kidneys to concentrate urine.
 Two forms
 Central (neurogenic) and nephrogenic diabetes
insipidus.
 Central diabetes insipidus results from
inadequate production of vasopressin
(antidiuretic hormone)
 Nephrogenic diabetes insipidus results from
ineffective action of vasopressin in the kidneys

3.  Antidiuretic hormone facilitates concentration
of the urine by stimulating reabsorption of
water from the distal tubule of the kidney.
 When ADH is inadequate, the tubules do not
resorb, leading to polyuria (passage of a
large volume of urine in a given period).
 Therefore, the body is unable to conserve
water, resulting in severe dehydration.

4. Causes
 The cause of 20% to 50% of cases of central diabetes
insipidus is unknown and is classified as being
idiopathic.
 Known causes of central diabetes insipidus include
 brain tumors, brain trauma, central nervous system
infection, and neurosurgery
 Genetic nephrogenic diabetes insipidus is not as
common as the acquired type, but its presentation is
more severe.
 Acquired nephrogenic diabetes insipidus may be
caused by
 drug toxicity, an adverse drug reaction, or illnesses that
impair the ability of the kidneys to concentrate urine

5. Clinical features
 Polyuria and polydipsia (excessive thirst)
are the cardinal signs of diabetes insipidus.
 Enuresis is common in children.
 Polydipsia is the body’s attempt to preserve
fluid balance.
 Additional manifestations observed in children
with diabetes insipidus include hypernatremia,
dilute urine, and dehydration

7.  In infants, symptoms may include irritability,
lethargy, vomiting, poor feeding, failure to thrive,
and constipation
 In all forms of diabetes insipidus, the urine cannot
be concentrated no matter how dehydrated the
child becomes. A dehydration episode usually
leads to the diagnosis.
 Serum sodium concentration and osmolality
increase rapidly to pathologic levels.
 Often an unconscious child is admitted to the
emergency department with dehydration and
hypernatremia

8. Diagnosis
 Initial testing involves serum electrolyte
concentrations and a urinalysis including specific
gravity and osmolality.
 Serum osmolality is increased (greater than 300
mOsm/kg), and urine osmolality is decreased (less
than 300 mOsm/kg).
 Urine specific gravity is decreased (less than 1.005),
and serum sodium is elevated (greater than 145
mEq/L).
 A CT scan or MRI may be ordered to visualize the
pituitary gland to detect a tumor.
 A fluid deprivation test evaluates the level of ADH and
helps to confirm the diagnosis

9. Assessment
 Increased excretion of large qualities (5-10 L per day) of hypotonic
urine
 Extreme thirst
 Altered LOC, orthostatic hypotension
 Poor skin turgor, dry mucus membrane
 Vital signs
 TEM, RR, HR INCREASED
 BP DECREASED
 ICP INCREASED
 CVP decreases
 Urine osmolality decreases to 200 mOsm/kg
 Serum osmolality increases to 300 mOsm/kg
 Increased serum Na >147mEq/L
 Plasma ADH is decreased

10. Multidisciplinary management
 Water deprivation test
 Measure the lab values every hourly
 Prohibit fluid intake
 Assess for negative results
 Urine specific gravity > 1.020
 Urine osmolality >800 mOsm/kg
 Assess for positive results
 >= 5% body weight loss
 Urine specific gravity not to increase for three
consecutive hourly measurements

11. Multidisciplinary management
 Vasopressin test
 Administer vasopressin subcutaneously
 Urine specimen collected every 3o mts for 2
hours and evaluated for quantity and osmolality.
(increased)
 Rehydration therapy with hypotonic solutions to
replace fluid and wt loss
 Rapid dehydration .. Later based on urine output
 Administer exogenous vasopressin
 Administer thiazide diuretics,Low sodium and low
protein diet in case of nephrogenic DI

12. NURSIN DIAGNOSIS
 Fluid volume deficit
 Risk for injury
 Altered peripheral tissue perfusion
 Altered cerebral perfusion/altered sensorium
 Parent anxiety
 Knowledge deficit

13. NURSING INTERVENTIONS
 Intake and output
 Alert urine output more than 200 ml/hr :Additional fluid
therapy
 Adequate fluids
 Administer hyperosmolar tube feeding
 Administer IV fluids
 Administer vasopressin
 Weigh daily
 Monitor fluid deficit
 Monitor lab values
 Monitor orientation, LOC and respiratory status
 Oral airway, O2 and resuscitation arrangement

14. NURSING INTERVENTIONS
 Reduce injury
 Gastric tube suction in comatose
 Head end elevation
 Seizure precautions
 Monitor Haematocrit
 Assess peripheral pulse
 Alert s/s of DVT
 ROM
 Parental and child education