Remember ADH is released as serum osmolality ⬆️ to ⬆️ renal water reabsorption, but in patients with DI this doesn’t occur and so they pass large vol watery urine - can be >10L/day!🛁
So this weekend you heard from our friends @BukuRenal that mismanagement of IV fluids can cause harm.
A group we’d like to highlight who can come to serious harm from ⬆️/⬇️ fluids is patients with
💦DIABETES INSIPIDUS 💦
See below 👇
#medtwitter #FOAMed
Remember ADH is released as serum osmolality ⬆️ to ⬆️ renal water reabsorption, but in patients with DI this doesn’t occur and so they pass large vol watery urine - can be >10L/day!🛁
Misunderstandings are so common (even with HCPs) that there is a campaign to change the name to "pituitary insipidus"
#NoTimeToDI
Pituitary adenomas themselves can cause lots of hormone dysfunction, but don't typically cause DI.
- renal disease
- electrolytes (⬇️ K, ⬆️ Ca – hence why hyperCa is dehydrating)
- drugs - can be seen with up to 15% of people taking LITHIUM 💊
They may have multiple other hormone deficiencies (e.g. cortisol, thyroid, sex hormones, growth hormone).
Adding synthetic ADH (desmopressin) – nasal spray or tablet – also helps by ⬇️ UO and so ⬇️polyuria/nocturia when given at🌛 - can be very important for QOL!
– ⬆️ fluid losses (e.g. fever, vomiting)
- ⬇️access to meds and/or fluids (esp if confused, drowsy, NBM etc)
= profound dehydration and ⬆️⬆️ Na despite “reassuring” UO
Sadly this has led to several deaths.
1.RECOGNISE DI – from PMHx, drug hx, medic alert, electronic record alert and SHARE INFO WITH TEAM 📢
-> rare condition often = ⬇️ awareness
2.Give usual desmo - 🔔CRITICAL MED🔔
3.Alert endo team 📞
4.Monitor – Na AT LEAST DAILY, fluid in/out
1.Consider ⬆️ level care and d/w specialist asap
2.Give desmo – can be given IV/IM (get help w conversion!) if usual routes not available 💉
3.Aim to bring down Na SLOWLY with fluids (<10mmol/24h)
5.👀 Na e.g. 4hrly, fluid in/out..
- those taking Desmopressin will struggle to excrete excesses if given too much fluid
- d/w specialist - may require Desmopressin dose change or delay to allow for controlled diuresis
Allow pt to take fluid orally (v IV) if possible so can self-regulate 👍
Did you know the Society for Endocrinology has published advice about DI for non-specialists?
You can find that here 👇
https://t.co/kHjDRH7G4G
More from Health
I applaud the #EUCancerPlan *BUT* caution: putting #meat 🥩 (a nourishing, evolutionary food) in the same box as 🚬 to solve a contemporary health challenge, would be basing policy on assumptions rather than robust data.
#FollowTheScience yes, but not just part of it!
THREAD👇
1/ Granted, some studies have pointed to ASSOCIATIONS of HIGH intake of red & processed meats with (slightly!) increased colorectal cancer incidence. Also, @WHO/IARC is often mentioned in support (usually hyperbolically so).
But, let’s have a closer look at all this! 🔍
2/ First, meat being “associated” with cancer is very different from stating that meat CAUSES cancer.
Unwarranted use of causal language is widespread in nutritional sciences, posing a systemic problem & undermining credibility.
3/ That’s because observational data are CONFOUNDED (even after statistical adjustment).
Healthy user bias is a major problem. Healthy middle classes are TOLD to eat less red meat (due to historical rather than rational reasons, cf link). So, they
4/ What’s captured here is sociology, not physiology.
Health-focused Westerners eat less red meat, whereas those who don’t adhere to dietary advice tend to have unhealthier lifestyles.
That tells us very little about meat AS SUCH being responsible for disease.
#FollowTheScience yes, but not just part of it!
THREAD👇
\U0001f534LIVE \U0001f4c5Today \u23f012:00 CET
— EU_HEALTH - #EUCancerPlan (@EU_Health) February 3, 2021
We are presenting today the #EUCancerPlan as part of a strong \U0001f1ea\U0001f1fa#HealthUnion
Follow the presentation live here: https://t.co/Cr8ATvzNkg#WorldCancerDay pic.twitter.com/zdByuklWV6
1/ Granted, some studies have pointed to ASSOCIATIONS of HIGH intake of red & processed meats with (slightly!) increased colorectal cancer incidence. Also, @WHO/IARC is often mentioned in support (usually hyperbolically so).
But, let’s have a closer look at all this! 🔍
2/ First, meat being “associated” with cancer is very different from stating that meat CAUSES cancer.
Unwarranted use of causal language is widespread in nutritional sciences, posing a systemic problem & undermining credibility.
3/ That’s because observational data are CONFOUNDED (even after statistical adjustment).
Healthy user bias is a major problem. Healthy middle classes are TOLD to eat less red meat (due to historical rather than rational reasons, cf link). So, they
4/ What’s captured here is sociology, not physiology.
Health-focused Westerners eat less red meat, whereas those who don’t adhere to dietary advice tend to have unhealthier lifestyles.
That tells us very little about meat AS SUCH being responsible for disease.