Question 1

4 out of 4 points

Scenario 1: Syndrome of Antidiuretic Hormone (SIADH)

A 77-year-old female was brought to the clinic by her daughter who stated that her mother had become slightly confused over the past several days. She had been stumbling at home and had fallen twice but was able to walk with some difficulty. She had no other obvious problems and had been eating and drinking. The daughter became concerned when she forgot her daughter’s name, so she thought she better bring her to the clinic.

HPI: Type II diabetes mellitus (DM) with peripheral neuropathy x 30 years. Emphysema. Situational depression after death of spouse 6-months ago

SHFH: – non contributary except for 40 pack/year history tobacco use.

Meds: Metformin 1000 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago

Labs-CBC WNL; Chem 7- Glucose-102 mg/dl, BUN 16 mg/dl, Creatinine 1.1 mg/dl, Na+116 mmol/L,

K+4.2 mmol/L, CO237 m mol/L, Cl97 mmol/L.

The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH).



1.     Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH 

Selected Answer: SIADH happens when increased ADH is produced in the body, causing water retention and electrolyte imbalance. Hypothalamus produces ADH, and the posterior pituitary secretes and stores ADH. ADH regulates water in the body through water retention, and it constricts blood vessels. It accomplishes this with kidneys. ADH causes renal tubules to retain water. An increased level of ADH causes extra water retention in the body, resulting in hyponatremia with hypo-osmolality and high urine osmolality.

Causes of SIADH can be damage to the hypothalamus or posterior pituitary gland or ADH being produced somewhere else. The symptoms continue to become more severe if the SIADH goes untreated, including confusion, hallucinations, seizures, and even coma. Based on the patient history, this patient has emphysema and currently smokes 40 packs of tobacco a year. The current lab work shows that patient’s carbon dioxide level is elevated at 37. The normal range for serum carbon dioxide is 23-29. Also, their sodium level is abnormal at 116. The normal range of serum sodium ranges between 135-and 145. When the serum sodium level is too low, the syndrome of inappropriate antidiuretic hormone secretion (SIADH) diagnosis is possible

Correct Answer:  

SIADH is a group of symptoms that occurs when antidiuretic hormone (ADH, arginine vasopressin) is secreted in the absence of osmotic or physiologic stimuli. These stimuli include: Increased serum osmolality, decreased plasma volume, and hypotension. A decrease in plasma osmolality normally inhibits ADH production and secretion. SIADH is characterized by fluid retention, dilutional hyponatremia, hypochloremia, concentrated urine, and lack of intravascular volume depletion. SIADH is characterized by normal to increased blood volume in normoproteinemia, nonedematous, and hyponatremic patients with normal renal and endocrine function.

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  • Question 2

4 out of 4 points

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Scenario 2: Type 1 Diabetes

A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.

PMH: noncontributory.


FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process

SH: denies alcohol, tobacco or illicit drug use. Not sexually active.

Labs: random glucose 244 mg/dl.

DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.


1.     Explain the pathophysiology of the three P’s for (polyuria, polydipsia, polyphagia)” with the given diagnosis of Type I DM.

Selected Answer: Diabetes type 1 is also known as juvenile diabetes and is dependent on insulin injections. Type 1 diabetes happens when the pancreas does not produce enough or any of the insulin hormones in the body, which are necessary to help regulate the glucose in the body. Common signs and symptoms of type 1 DM can appear relatively suddenly. These symptoms include; increased thirst(polydipsia), frequent urination (polyuria), bed-wetting in children who previously did not wet the bed during the night, extreme hunger (polyphagia), and unintended weight loss, irritability and other mood changes, fatigue, weakness, and blurred vision.

Pathophysiology of Polyuria

Polyuria is one of the diabetes symptoms which means urine excretion is more than usual. High amounts of solutes within the renal tubules cause a passive osmotic diuresis and increased urine volume. In Diabetic patients, high urinary glucose levels exceed tubular reabsorption capacity, leading to increased glucose levels in the renal tubules; water follows passively, resulting in glucosuria and increased urine volume.

Pathophysiology of Polydipsia

Polydipsia can be the primary indication that blood glucose levels may be high. In diabetic patients, a high blood glucose level causes the kidney to produce more urine to remove excess glucose from the body. Moreover, intracellular dehydration occurs due to high blood glucose levels, and the hypothalamus activation sends the signal for thirst (Christ-Crain et al., 2019, pp. 2-3). The brain tells the body to increase the amount of fluid ingested because more urine is being produced to decrease the glucose circulating in the bloodstream. Seladi-Schulman (2020) states that Persistent feelings of thirst can also be caused by dehydration, osmotic diuresis, an increase in urination due to excess glucose entering the kidney tubules which can’t be reabsorbed, leading to increased water in the tubules, and mental health issues, such as psychogenic polydipsia.

Pathophysiology of Polyphagia

Polyphagia is an excessive hunger feeling. This hunger usually dissipates once the person satisfies the craving by eating. In diabetics, the sense of hunger does not dissipate following consuming food. in diabetes, glucose can’t enter cells to be used for energy due to either low insulin levels or insulin resistance. The issue occurs when the conversion from glucose to energy is impaired, leading to continued hunger. With this being said, when the person consumes food, the glucose from that food then leads to increased blood glucose levels.

Correct Answer:  

(polyuria) Hyperglycemia acts as an osmotic diuretic. The amount of glucose filtered by the glomeruli of the kidneys exceeds the amount that can be reabsorbed by the renal tubules. Glycosuria results accompanied by large amounts of water lost in the urine. (polydipsia) Because elevated blood glucose levels, water is osmotically attracted from body cells which results in intracellular dehydration and hypothalamic stimulation of thirst. (polyphagia) Depletion of cellular stores of carbohydrates, fats, and proteins results in cellular starvation and a corresponding increase in hunger.

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