Does anyone else here feel very viscose?

[anita]

That's odd.  Wouldn't higher levels cause MORE concentrated urine?  It's the lack of ADH (either from drop of pituitary function or inability of kidney absorption) to cause DI and very dilute urine.

How does this cause dilute urine if you have too much ADH?  Now I'm really curious...lol

[Linda196]

It has to do with the balance between the sodium content of the serum and the excreted sodium in the urine, they both affect osmolality and in the case of SIADH it's like a "washout " of sodium, the ADH prevents re-absorption of sodium at the renal tubercles , the kidney thinks it's building up and flushes water through to get rid of it. It's much more complex and I don't get it myself other than the final outcomes, what to watch for from a nursing and patient perspective, and how to treat them.

[anita]

That's because SIADH causes too much ADH being produced resulting in a sodium drop (the washout you mentioned)...to dangerous levels.  DI is the opposite...too little ADH.  Whether from lack of pituitary production (tumor, etc) or kidney involvement, DI is present when there is not enough ADH to concentrate urine.  SIADH makes it hard to get rid of urine (and it builds up and sodium drops), where DI patients are going non-stop and sodium increases.  DI does not typically have fluid restrictions.  It is treated other ways to either increase ADH with medicine or reduce inflammation on kidneys to promote better ADH acceptance.  DI patients only have fluid restrictions for the test...done in the ICU or MICU and no water, food, anything (all meds by IV with no extra saline) for minimum of 24-36 hours.  Then urine osmality and specific gravity tested hourly.  Of course, they also check basic electrolytes. etc to make sure patients stays stable.

SIADH sounds horrible!  DI isn't much fun either, but once the right treatment is found, it can be manageable.

One of the Endo's at Hopkins read an experimental treatment for my type of DI (Nephrogenic) which was to give additional ADH...and the body was to supposed to respond with the overload (too much ADH) by the kidneys accepting more.  Huge mistake, and the extra ADH caused the very thing SIADH causes...dangerous drops in sodium.  Sent me to the ER within a couple hours of the very dose.  I can't imagine you dealing with this for 2 YEARS!!!  I had a hard time with one day!!