00:00
Now let's look at this at nighttime because normally ADH is what our body puts out at
nighttime so we can sleep and not have to get up to pee. That's a beautiful thing.
00:11
Isn't it? Because once I am settled in and all comfortable, I do not want to have to get
out of my bed. I mean you guys know what I'm talking about. Right? If you ever had that
thought where you wake up and you think "Oh I have to pee. No, I think I can make it.
00:25
I think I can make it til morning." Am I the only one that does that? Because yes when
you're all warm and snugly I do not want to get out. But this is what ADH's job is.
00:35
ADH's job is to allow me to get some good rest and we hang on to that fluid during the
night. So here is how it goes down. When I'm younger, when I'm more like a young adult,
I have more ADH than when I'm older. So, the kidneys know to reabsorb water and
I have less urine and I can sleep peacefully through the night. We talked about young
Jose, now let's compare old Jose. Remember, healthy, fit, normal aging of the kidneys.
01:06
Let's talk about what his experience is like. Now remember his granddaughter was really
concerned about how many times he got up during the night, nocturia, to use the
restroom. Well, let me explain why that's normal. See, older Jose has less ADH, antidiuretic
hormone. So since he has less of that hormone available, he is going to hang on to less
water. Now let's make sure that's clear. Remember the role of ADH is to be against
diuresing. When I'm against diuresing, I reabsorb that fluid back into my body instead
of peeing it out. With less ADH available, then I'm going to pee out more than I normally
would when I was younger. See, 2 things. You have less ADH as you age and your tubules
are less responsive to the ADH you do have. So it's actually a double whammy. As you
age, older Jose even though is healthy and fit, he has less ADH available and his tubules
are less responsive to the ADH that he does have. That's why he ends up with the
same urinary production or more than he normally would have at night because he
doesn't have the same amount of ADH which normally allows him to sleep through the
night without having to pee. He has less ADH, his tubules are less responsive to it and
that's why he is ending up having to get up during the night to use the restroom or
nocturia. Now, we looked at young Jose, we've looked at aging Jose, now I want to take
a look and compare how Enrique's experience was so different. Now, Jose has nocturia
having to urinate at night, but Enrique has nocturnal polyuria. Remember that word we
introduced earlier. Poly means multiple times. So, Jose 3 times a night, Enrique like 6 times
or more during the night. Now both of them have less ADH and both of their kidneys are
less responsive to ADH, but Enrique again has had a different path. He has congestive
heart failure, he has chronic kidney disease. So it's very common for people with
congestive heart failure when they lay flat, it's easier for their heart to pump, they
end up pushing out some of that extra fluid during the nighttime. So while both have less
ADH, they're less responsive to ADH. Jose is a strong, healthy, aged successfully,
elderly client. Enrique has had some big challenges and life events. So that is why he has
nocturnal polyuria. He urinates more often during the night than the average elderly
client. Now there are some other things that can also increase the risk for having
polyuria. There are some medications like diuretics which is why we always encourage
patients to take their diuretics early in the morning instead of at night. There is a loop
diuretic called furosemide. You may know it as Lasix. But we would not want to give
that to someone at nighttime because that will definitely help them experience
nocturnal polyuria. So it's important in timing with medications that you take those
medications earlier in the day so as you're going multiple times to the restroom,
it's during the day and not during the night. Remember, these are elderly clients.
04:40
We would prefer that we limit the number of times they have to get up during the night
because of an increased risk for falls when you're kind of in a sleepy state. Now
there are other medications, some antidepressants, some anti-seizure medications
that will also increase the need to urinate. So keep that in mind, it's really important
that you do a very clear assessment of the medications that your patients are on.
05:05
So we're going to give you even more information about nocturia. We're going to look at
healthy kidneys when Jose is 20 and when he is at 85. Now you're going to see a lot
of numbers on the screen. The idea is not that you memorize these numbers, the idea
is you look at the difference between young Jose and older Jose. So we're going to
talk about them in the daytime and in the nighttime. Look at urine volume so you can
see the difference in young Jose between his nighttime volume and his daytime volume.
05:36
Look at old Jose. Wow. Now look at the difference between old and young. What
pattern do you see? Now the biggest one is old Jose is literally putting out more urine
at night than young Jose and that's why he is having to get up during the night. Now
urine osmolality. That's looking at the concentration of the solutes in the solvent or
in the urine. So you can look at the numbers there when you're young, usually 700 during
the day about 8:30 at night for the young guy. But then look what we have here for
older Jose. Look at that in the daytime, in the nighttime it's very different than what
young Jose experienced. Now keep in mind, our older clients are at increased risk
when they're being dehydrated or when they have fluid volume overload, but here's
one of the reasons they have increased risk for dehydration. We're looking at ADH
now. Now we have spent a lot of time talking about that. Antidiuretic hormone. Look at
young Jose. You'll see that at nighttime he has almost twice as much ADH. Now slide
on over to old Jose's column. Whoah, there's a big difference. Right? Compare old Jose's
ADH at nighttime to young Jose's ADH at nighttime. That helps shed a lot of light unlike
older Jose is having to get up more times during the night when he is in his 80s than
when he did when he was in his 20s. Now, you notice that we're going over some of these
concepts more than once. That's a good thing for you because we're helping you get
things from your short-term memory to your working memory so we can eventually
help you get them into your long-term memory. So that's why you're seeing some
of these concepts more than once. We wanted you to have this summary slide so you
can see everything all in one place and comparing the changes from a young man's
kidney to Jose as an old man's kidney. Now this last one is probably new to you.
07:51
Right? This may not be something that you feel incredibly familiar with, but know that
ANH also increases nocturia. So, poor Jose. He's got less ADH, his tubules are less
responsive to the ADH he does have, and if that's not enough now we're going to deal
with ANH and that's also going to increase his nocturia. Now, let me break it down for
you and we will explain why.