Nursing Care Plan for Diabetes Insipidus

Pathophysiology

Diabetes insipidus refers to the condition where the kidneys are unable to retain water. Even though the patient may be dehydrated, the kidneys cannot balance the fluid and produce large amounts of insipid urine (dilute and odorless). The kidneys normally produce 1-2 quarts of urine per day, but with diabetes insipidus, they may produce 3 – 20 quarts per day. This results in the patient feeling very thirsty and have the urge to drink large amounts of liquid.

Etiology

The hypothalamus produces a hormone called vasopressin, an antidiuretic hormone (ADH) that tells the kidneys how much fluid to absorb from the bloodstream. This normally results in a lower amount of urine produced.  When there is damage to the hypothalamus (Central diabetes insipidus, or CDI) or the kidneys are not able to respond to the vasopressin (Nephrogenic diabetes insipidus or NDI), the kidneys do not know when to stop removing fluid from the body, even if the body is already dehydrated. This results in the patient feeling extremely thirsty, which prompts them to drink more fluids, and therefore, secrete more dilute urine.

Desired Outcome

Prevent dehydration, manage symptoms and prevent complications

Diabetes Insipidus Nursing Care Plan

Nursing Interventions and Rationales

• Monitor I & O, daily weights, and polydipsia

• Monitor for signs/symptoms of hypovolemia

• Monitor for signs of hypotension and provide education and assistance with ambulation

• Encourage hydration and provide easy access to fluids; administer IV fluids if necessary
  • Hypotonic-  D5W or 0.45% sodium chloride
  • Isotonic – NS (0.9% sodium chloride) if hemodynamically unstable

• Monitor labs/electrolyte balance
  • Serum and urine osmolality
  • Serum and urine sodium levels
  • Serum potassium

• Administer medications appropriately
  • Chlorpropamide or carbamazepine – stimulates the release of vasopressin (ADH)
  • Hydrochlorothiazide- may be used for nephrogenic DI
  • Aqueous vasopressin – used for short term DI
  • Pitressin tannate is a long-acting vasopressin

• Provide easy access to the bathroom

• Prevent injury and initiate fall precautions

• Assess for skin integrity, apply skin barriers as needed

References

• https://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/symptoms-causes/syc-20351269
• https://www.niddk.nih.gov/health-information/kidney-disease/diabetes-insipidus
• https://www.webmd.com/diabetes/guide/what-is-diabetes-insipidus#1