Neurological Disorders Q 80 - Gyan Darpan : Learning Portal
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Monday, 18 April 2022

Neurological Disorders Q 80

The client with a head injury has been urinating copious amounts of dilute urine through the Foley catheter. The client’s urine output for the previous shift was 3000 ml. The nurse implements a new physician order to administer:
     A. desmopressin (DDAVP, Stimate)
     B. Dexamethasone (Decadron)
     B. Dexamethasone (Decadron) C. ethacrynic acid (Edecrin)
     D. mannitol (Osmitrol)

Correct Answer: A. Desmopressin (DDAVP, stimate)

A complication of a head injury is diabetes insipidus, which can occur with insult to the hypothalamus, the antidiuretic storage vesicles, or the posterior pituitary gland. Urine output that exceeds 9 L per day generally requires treatment with desmopressin. Desmopressin administration can be utilized to distinguish between central vs. nephrogenic diabetes insipidus, with a positive response noted in central diabetes insipidus, meaning the kidneys respond appropriately to desmopressin with the expected concentration of the urine and increased reabsorption of fluids, resulting in eutonic urine.

Option B: Dexamethasone, a glucocorticoid, is administered to treat cerebral edema. This medication may be ordered for the head injured patient. Dexamethasone has a wide variety of uses in the medical field. As a treatment, dexamethasone has been useful in the treatment of acute exacerbations of multiple sclerosis, allergies, cerebral edema, inflammation, and shock.
Option C: Ethacrynic acid is a loop diuretic that gained FDA approval for widespread use in 1967. Unlike other loop diuretics, ethacrynic acid is a novel drug due to the absence of a sulfonamide group in its structure, allowing its use in critically ill patients with life-threatening sulfa-allergies. In adults, ethacrynic acid is a choice for the relief of edema in patients with renal failure, congestive heart failure, and cirrhotic ascites in the setting of sulfonamide hypersensitivity and treatment-resistant pathologies.
Option D: Mannitol is a diuretic, which would be contraindicated. Mannitol is a six-carbon, linear, simple sugar which is only mildly metabolized by the body and primarily excreted rapidly by the kidneys when given intravenously and poorly absorbed when taken orally.

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