Diabetes Insipidus

[qw098]

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Dude just needs water cuz his pituitary gland isn't working so he isn't pumping out enough ADH...

How come I can't give my patient just water instead of D5W?

 

[dfib slim]

Dude just needs water cuz his pituitary gland isn't working so he isn't pumping out enough ADH...

How come I can't give my patient just water instead of D5W?

Probably don't want to lower his sodium too quickly and risk cerebral edema.

 

[Siggy]

D5W will lower sodium just as quickly as free water, and you can give your patient ORAL free water. IV, however, is because you still need what ever fluid to be relatively isotonic or else the cells go poof (lyse).

...and yes, you don't want to lower it too quickly, thus you constantly monitor the sodium. You also want to give subq desmopressin titrated to urine output.

 

[Jabbed]

Because IV free water lyses RBCs.

 

[qw098]

Because IV free water lyses RBCs.

Thanks guys!

 

[Transposony]

So, why doesn't oral water lyse the epithelial cells of the GIT?

 

[Jabbed]

So, why doesn't oral water lyse the epithelial cells of the GIT?

Greater density of Na/K pumps and K and Cl leak channels on the luminal and basolateral surfaces and gap junctions between individual cells. A large water bolus is likely to cause the collective epithelium to swell only slightly. In contrast RBCs are little lonely cells with three Na/K pumps and are extremely susceptible to osmotic shifts.

 

[Transposony]

Greater density of Na/K pumps and K and Cl leak channels on the luminal and basolateral surfaces and gap junctions between individual cells. A large water bolus is likely to cause the collective epithelium to swell only slightly. In contrast RBCs are little lonely cells with three Na/K pumps and are extremely susceptible to osmotic shifts.

Mucin

 

[syoung]

you'd have to give a bolus of concentrated sugar water do some damage in the GIT, IIRC