Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?
A. Fluid intake is less than 2,500 ml/day.
B. Urine output measures more than 200 ml/hour.
C. Blood pressure is 90/50 mm Hg.
D. The heart rate is 126 beats/minute.
Correct Answer: A. Fluid intake is less than 2,500 ml/day.
Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. It is essential to replete fluid losses in diabetes insipidus, as some patients may have thirst impairment and will not respond adequately to water intake.
Option B: A urine output of 200 ml/hour indicates continuing polyuria. The preferred therapy is DDAVP. Typically, therapy is maintained for the duration of central diabetes insipidus, which varies depending on the cause. The minimum dose should be administered to control polyuria adequately.
Option C: A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn’t been effective. The prognosis for most patients with DI is excellent as long as the underlying primary cause can be treated. Lithium discontinuation can restore normal kidney function, but the nephrogenic DI may be permanent in some patients.
Option D: It is important to monitor hyponatremia, as water retention can lead to sodium concentration changes that may cause brain injury. The patients and families should be educated to observe for symptoms of nausea, vomiting, lethargy, headaches, confusion, seizures, and coma.
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