Episode 52:

SIADH and Diabetes Insipidus

In this episode we are going to discuss Tissue nanotransfection technology, a new emerging technology that can manipulate cell function. We are also going to introduce you to SIADH and Diabetes Insipidus, 2 fairly common issues we see in the hospital.

SHOW NOTES

Tissue nano transfection technology

Tissue nano transfection technology (TNT) is a relatively new field of regenerative medicine research that can help in regrowth and repair of damaged tissue inside the human body.

Within tissues, the extracellular matrix (ECM) surrounding the cells plays an important role in the storage, activation, and release of biological factors. The ECM also plays a role in interactions between cells. For the successful regeneration of tissues, it is necessary to engineer biomaterials that emulate the properties of the ECM.

Extracellular matrix helps with cell adhesion, migration, proliferation, and differentiation.

A new non-invasive technology – Tissue Nanotransfection (TNT) – has been developed by researchers at Ohio State University to reprogram and grow skin cells directly on the body. The device delivers genes to skin cells by passing a strong electrical current through the chip and transforming the cells.

The technology has two major components: First, nanotechnology-based chip hardware is designed to deliver cargo to adult cells in the live body. Second, the design of specific biological cargo for cell conversion allows such cargo, when delivered using the above hardware, to convert an adult cell from one type to another of interest.

In this method, synthetic RNA and DNA are loaded into a chip device. The chip is embedded with tiny needles that contain nanochannels into which the synthetic RNA and DNA is loaded. This biological cargo is delivered into the cells by a small electrical charge that is hardly felt by the patient. This procedure takes less than a second and has demonstrated 98% efficiency.

Studies have shown that TNT helps restore blood flow to the injured legs of mice by reprogramming their skin cells to vascular cells. Researchers observed that active blood vessels were formed within two weeks and blood flow returned to the legs by the third week. TNT was also used to grow new brain tissue in stroke-induced mice. The study observed restoration of bodily functions by injecting new brain tissue that was grown from the animals’ skin.

SIADH and Diabetes Inscipitis

What is ADH?

    • A normal range is between 1-5 pg/ml
    • ADH is also known as vasopressin. It is made in the hypothalamus and stored in the pituitary.
    • ADH helps the kidneys, and body, conserve the correct amount of water. It regulates and controls the amount of water in your blood.
    • Osmotic sensors and baroreceptors work with ADH to maintain water metabolism and regulation.

SIADH

Syndrome of inappropriate antidiuretic hormone secretion occurs when excessive levels of antidiuretic hormones are produced.

  • The syndrome causes the body to retain water

What happens?

The body holds on to water and causes:

  • Dilutional hyponatremia: Na<135
  • Results from excess water, not a deficiency in Na
  • Hypo-osmolality in blood: <280
  • High urine osmolality: >850
  • The test requires to restrict fluid for 12-14 hours
  • High urine specific gravity: > 1.020
  • A decrease in urine output

What causes it?

  • Lung disease
    • Oat cell carcinoma: bronchogenic cancer that makes its own ADH
    • Viral Pneumonia: hypoxic areas of the lung stimulate posterior pituitary to put out ADH
  • Problems with the hypothalamus, head trauma, tumors, encephalitis, meningitis.
  • Guillain-Barre syndrome
  • Thyroid/parathyroid deficiencies
  • Anesthesia and analgesics make you release ADH
  • Stress makes you release ADH

Complications

  • The main one is seizures due to fluid shift into the cell.
  • n/v
  • Cramps
  • Stupor, coma, irritability, confusion, hallucinations

Treatment

  • Treat underlying cause
  • Fluid restriction
  • 3% NaCl, hypertonic, when Na <120
    • Give slow and reassess for fluid overload and CHF
  • Give phenytoin to prevent seizures and inhibit ADH secretion

 

Diabetes Insipidus

DI is a condition in which your kidneys are unable to hold onto water due to a lack of ADH.

The kidneys cannot concentrate urine.

What happens?

  • Hypovolemia
  • Hypernatremia: >145
  • Hyperosmolarity in blood: >295
  • Hypo-osmolality in urine: <300
  • Low specific gravity: <1.005
  • Increased urine output

What causes it?

  • Head problems, surgery, trauma
  • Dilantin, lithium, antivirals
  • Damage to pituitary or hypothalamus
  • Autoimmune issues

Complications

  • Excessive thirst, dehydration, electrolyte imbalances
  • Seizures

Treatment

  • Underlying cause
  • Give ADH via vasopressin
  • Rehydration with .9 NaCl

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