Patho Exam 4
Sort Which of the following types of diabetes is controlled primarily through diet, exercise, and oral medications? A. Diabetes insipidus B. Diabetic ketoacidosis C. Type 1 diabetes mellitus D. Type 2 diabetes mellitus D A client presenting with low levels of adrenocortical hormones in the blood or urine may have which of the following conditions? A. Addison's Disease B. Cushing's syndrome C. Hyperthyroidism D. Hypothyroidism A Secretion of thyroid-stimulating hormone (TSH) by which of the following glands controls the rate at which thyroid hormone is released? A. Adrenal gland B. Parathyroid gland C. Pituitary gland D. Thyroid gland C The hormones triiodothyronine (T3) and thyroxine (T4) affect which of the following body processes? A. Blood glucose level & glyconeogenesis B. Growth & development as well as metabolic rate C. Growth of bones, muscles, & other organs D. Bone resorption, calcium absorption, and blood calcium levels B Which of the following groups of hormones are released by the medulla of the adrenal gland? A. Epinephrine & norepinephrine B. Glucocorticoids, mineralocorticoids, & androgens C. Triiodothyronine (T3), thyroxine (T4) , and calcitonin D. Insulin , glucagon, and somatostatin A Diabetes Mellitus is a group of metabolic disorders in which the body's capacity to utilize glucose, fat, and protein are disturbed due to insulin deficiency or insulin resistance. A. True B. False A Which of the following conditions is caused excessive secretion of ADH (vasopressin)? A. Thyrotoxic crisis (storm) B. Diabetes insipidus C. Primary Adrenocortical insufficiency D. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) D Which of the following disease processes releases enough insulin to prevent ketosis but not enough to prevent hyperglycemia? A. Dia Continue reading >>
What Is Diabetes Insipidus?
Diabetes insipidus, not to be confused with the more common diabetes mellitus, is a relatively rare disorder resulting from a failure to produce sufficient amounts of vasopressin, also known as antidiuretic hormone (ADH). Vasopressin, produced by the hypothalamus and secreted by the posterior pituitary gland, helps the kidneys to reabsorb water and maintain proper fluid balance. If the pituitary fails to produce enough ADH, water is not conserved but simply passed through the kidneys and excreted, typically in very large quantities. More rarely, the kidneys fail to respond properly to ADH; this is known as nephrogenic diabetes insipidus. Dehydration is the primary health risk associated with either form. Diabetes insipidus affects both sexes equally. With proper treatment, overall prognosis is good (except in cases caused by cancer). What Causes Diabetes Insipidus? In approximately one third of all cases, the cause of diabetes insipidus is unknown. Hereditary factors may play a role in some cases. Damage to the pituitary gland from a head injury, a hypothalmic tumor, or inflammation, radiation therapy, or surgery may lead to diabetes insipidus. The most frequent cause of nephrogenic diabetes insipidus is therapy with lithium. Tuberculosis Blockage in an artery leading to the brain Symptoms of Diabetes Insipidus Frequent and excessive urination (output may be as high as 25 to 35 quarts within 24 hours and may be as frequent as every 30 minutes, even at night) Extreme thirst Dry skin Constipation Emergency symptoms of dehydration, including dizziness, weakness, and unconsciousness Prevention of Diabetes Insipidus There is no known way to prevent diabetes insipidus. Diagnosis of Diabetes Insipidus Physical examination and patient history are performed. Diagnosis of diabete Continue reading >>
Nephrogenic Diabetes Insipidus
In nephrogenic diabetes insipidus, the kidneys produce a large volume of dilute urine because the kidney tubules fail to respond to vasopressin (antidiuretic hormone) and are unable to reabsorb filtered water back into the body. Often nephrogenic diabetes insipidus is hereditary, but it can be caused by drugs or disorders that affect the kidneys. To treat nephrogenic diabetes insipidus, people restrict salt in their diet and sometimes take drugs to reduce the amount of urine excreted. Both diabetes insipidus and the better-known type of diabetes, diabetes mellitus, result in the excretion of large volumes of urine. Otherwise, the two types of diabetes are very different. Two types of diabetes insipidus exist. Nephrogenic diabetes insipidus and diabetes mellitus are very different, except that both cause people to excrete large amounts of urine. Causes Normally, the kidneys adjust the concentration and amount of urine according to the body’s needs. The kidneys make this adjustment in response to the level of vasopressin in the blood. Vasopressin, which is secreted by the pituitary gland, signals the kidneys to conserve water and concentrate the urine. In nephrogenic diabetes insipidus, the kidneys fail to respond to the signal. Nephrogenic diabetes insipidus may be Hereditary nephrogenic diabetes insipidus In hereditary nephrogenic diabetes insipidus, the gene that typically causes the disorder is recessive and carried on the X chromosome, one of the two sex chromosomes, so usually only males develop symptoms. However, females who carry the gene can transmit the disease to their sons. Rarely, another abnormal gene can cause nephrogenic insipidus in both males and females. Acquired nephrogenic diabetes insipidus Symptoms People may pass from 1 to 6 gallons (3 to 20 lite Continue reading >>
Diabetes Mellitus
Return to The Medical Biochemistry Page Diabetes is any disorder characterized by excessive urine excretion. The most common form of diabetes is diabetes mellitus, a metabolic disorder in which there is an inability to oxidize carbohydrate due to disturbances in insulin function. Diabetes mellitus is characterized by elevated glucose in the plasma and episodic ketoacidosis. Additional symptoms of diabetes mellitus include excessive thirst, glucosuria, polyuria, lipemia and hunger. If left untreated the disease can lead to fatal ketoacidosis. Other forms of diabetes include diabetes insipidus and brittle diabetes. Diabetes insipidus is the result of a deficiency of antidiuretic hormone (ADH, also referred to as vasopressin or arginine vasopressin, AVP). The major symptom of diabetes insipidus (excessive output of dilute urine) results from an inability of the kidneys to resorb water. Brittle diabetes is a form that is very difficult to control. It is characterized by unexplained oscillations between hypoglycemia and acidosis. Criteria, which clinically establish an individual as suffering from diabetes mellitus, include: 1. having a fasting plasma glucose level in excess of 126mg/dL (7mmol/L). Normal levels should be less than 100mg/dL (5.6mmol/L) or: 2. having plasma glucose levels in excess of 200mg/dL (11mmol/L) at two times points during an oral glucose tolerance test, OGTT, one of which must be within 2 hrs of ingestion of glucose. Different clinical labs may use different units for the measurement of serum glucose concentrations, either in mmol/L or mg/dL. One can easily interconvert these values using the following formulas: mg/dL x 0.0555 = mmol/L (or simply divide mg/dL by 18) mmol/L x 18.0182 = mg/dL (or simply multiply mmol/L by 18) The earlier a person is dia Continue reading >>
What Is Diabetes Insipidus Vs. Diabetes Mellitus?
Diabetes mellitus is a condition caused by a lack of insulin or resistance to it, but what is diabetes insipidus? You may think, since they have a similar name, that diabetes mellitus and diabetes insipidus are related, but that could not be further from the truth. Diabetes insipidus (or DI) is a very rare disorder which has many of the common symptoms associated with diabetes mellitus, but the two conditions are totally unrelated. Occasionally, DI is called “water diabetes” to make a distinction between it and the more prevalent diabetes mellitus, otherwise known as “sugar diabetes.” What is Diabetes Insipidus Characterized By? The primary characteristic of DI is urinating often. However, as opposed to other forms of diabetes, the urine is not loaded with glucose but instead is heavily diluted, it’s mostly water. The repeated urination results in the need to drink a lot more. This interferes with sleep due to the necessity to get up during the night to use the bathroom, and may on occasion bring about involuntary urination while asleep (bedwetting). Youngsters with this condition might be cranky or lethargic and may even have fever, diarrhea or vomiting What is Diabetes Insipidus’ 4 Types? Diabetes Insipidus is categorized into 4 different types, each one with different treatments and causes. These 4 forms of DI are: Neurogenic (or Central): This is the most widespread form of DI and is the result of a shortage of vasopressin, the hormone which usually acts on the kidneys to lessen urine production. This is typically a result of damage to the rear of your pituitary gland which is where vasopressin is created. The pituitary gland could be damaged by a number of illnesses as well as tumors, bacterial infections, head trauma along with hereditary defects. Neur Continue reading >>
Diabetes Insipidus
What are the types of diabetes insipidus? Central Diabetes Insipidus The most common form of serious diabetes insipidus, central diabetes insipidus, results from damage to the pituitary gland, which disrupts the normal storage and release of ADH. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking desmopressin, a person should drink fluids only when thirsty and not at other times. The drug prevents water excretion, and water can build up now that the kidneys are making less urine and are less responsive to changes in body fluids. Nephrogenic Diabetes Insipidus Nephrogenic diabetes insipidus results when the kidneys are unable to respond to ADH. The kidneys' ability to respond to ADH can be impaired by drugs-like lithium, for example-and by chronic disorders including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of nephrogenic diabetes insipidus is never discovered. Desmopressin will not work for this form of diabetes insipidus. Instead, a person with nephrogenic diabetes insipidus may be given hydrochlorothiazide (HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again, with this combination of drugs, one should drink fluids only when thirsty and not at other times. Dipsogenic Diabetes insipidus Dipsogenic diabetes insipidus is caused by a defect in or damage to the thirst Continue reading >>
Diabetes Mellitus
There are two forms of diabetes in dogs: diabetes insipidus and diabetes mellitus. Diabetes insipidus is sometimes called "drinking diabetes" and diabetes mellitus is also known as "sugar diabetes". Diabetes insipidus is a very rare disorder that results in failure to regulate body water content. Diabetes mellitus is more common in dogs, and is frequently diagnosed in dogs five years of age or older. This is also known as adult-onset diabetes. There is a congenital form that occurs in puppies called juvenile diabetes, but this is rare in dogs. Diabetes mellitus is a disease of the pancreas. This is a small but vital organ located near the stomach. It has two significant populations of cells. One group of cells produces the enzymes necessary for proper digestion. The other group, called beta-cells, produce the hormone insulin. Simply put, diabetes mellitus is a failure of the pancreatic beta cells to regulate blood sugar. Some people with diabetes take insulin shots, and others take oral medication. Is this true for dogs? In humans, two types of diabetes mellitus have been discovered. Both types are similar in that there is a failure to regulate blood sugar, but the basic mechanisms of disease differ somewhat between the two groups. Most dogs with diabetes mellitus will require daily insulin injections to regulate their blood glucose. Type I or Insulin Dependent Diabetes Mellitus results from total or near-complete destruction of the beta-cells. This is the most common type of diabetes in dogs. As the name implies, dogs with this type of diabetes require insulin injections to stabilise blood glucose levels. Type II or Non-Insulin Dependent Diabetes Mellitus is different because some insulin-producing cells remain. However, the amount produced is insufficient, there is a Continue reading >>
Diabetes Insipidus
Diabetes Insipidus Types Signs Diagnosis Treatment Personal Stories Ziggy, Puff, & Simone the cats Sonny the Samoyed Ferris Resources References What is Diabetes Insipidus? Diabetes insipidus (DI) is a disorder of water balance. The animal is unable to concentrate urine, so the urine volume is very high and the urine is dilute. "Insipid" means tasteless -- referring to the dilute urine. This disease is rare in both dogs and cats. The condition is usually permanent, and the prognosis is good. Without treatment, dehydration leads to stupor, coma, and death. This is a completely different disease from Diabetes Mellitus (DM), a disorder of sugar metabolism involving the hormone insulin. We include the information here because people are often looking for resources and we had some owners of pets with DM who also have experience with DI. Types of diabetes insipidus Central Diabetes Insipidus - caused when the pituitary gland does not secrete enough antidiuretic hormone (ADH) [also called vasopressin]. This type of DI may be the caused by a congenital defect, trauma, a tumor on the pituitary gland, or unknown causes. Nephrogenic Diabetes Insipidus - caused when the kidneys do not respond to the ADH that is produced by the pituitary gland. This type of DI may be caused by a congenital defect, drugs, or caused by other metabolic disorders polyuria (excessive urination) polydipsia (excessive drinking) Diagnosis includes ruling out other diseases such as hyperadrenocorticism (Cushing's disease), diabetes mellitus, hyperthyroidism (in cats), renal failure, liver disease, pyometra (infection of the uterus), and other disorders. Images of the pituitary gland may be taken to determine if there is a tumor. A water deprivation test or an ADH trial with DDAVP may be done. These tests det Continue reading >>
Transient Diabetes Insipidus In Pregnancy
[1] Endocrinology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto1099-023, Lisboa, Portugal [2] Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK Learning points Gestational DI is a rare complication of pregnancy occurring in two to four out of 100 000 pregnancies. It usually develops at the end of the second or third trimester of pregnancy and remits spontaneously 4–6 weeks after delivery. Gestational DI occurrence is related to excessive vasopressinase activity, an enzyme expressed by placental trophoblasts during pregnancy, which metabolises AVP. Its activity is proportional to the placental weight, explaining the higher vasopressinase activity in third trimester or in multiple pregnancies. Vasopressinase is metabolised by the liver, which most likely explains its higher concentrations in pregnant women with hepatic dysfunction, such acute fatty liver of pregnancy, HELLP syndrome, hepatitis and cirrhosis. Therefore, it is important to assess liver function in patients with gestational DI, and to be aware of the risk of DI in pregnant women with liver disease. Serum and urine osmolality are essential for the diagnosis, but other tests such as serum sodium, glucose, urea, creatinine, liver function may be informative. The water deprivation test is normally not recommended during pregnancy because it may lead to significant dehydration, but a pituitary MRI should be performed at some point to exclude lesions in the hypothalamo-pituitary region. These patients should be monitored for vital signs, fluid balance, body weight, fetal status, renal and liver function, and treated with desmopressin. The recommended doses are similar or slightly higher than those recommended for centr Continue reading >>
Diabetes Insipidus Diagnosis
Diabetes insipidus presents with symptoms that are very similar to the much more common diabetes mellitus. Increases in thirst and urination are seen with both forms of diabetes. Diagnosis of diabetes insipidus therefore involves ruling out diabetes mellitus and then establishing which type of diabetes insipidus a patient has. The treatment approach depends on whether the patient has cranial (or central) diabetes insipidus or nephrogenic diabetes insipidus. The tests for diagnosing diabetes insipidus include: However, if the injection of ADH fails to stop urine production, a diagnosis of nephrogenic diabetes insipidus is confirmed as adequate amounts of ADH are present but the kidneys are simply not responsive to it. Blood and urine is tested for levels of glucose, calcium and potassium. In cases of high sugar in the urine, diabetes mellitus may be suspected. The water deprivation test: This test involves depriving a patient of water for several hours. Individuals with diabetes insipidus pass large amounts of water in their urine despite this deprivation whereas a healthy individual would pass a small amount of concentrated urine. Vasopressin test: If the patient's urine is not concentrated enough, they may be administered an injection of the hormone vasopressin or antidiuretic hormone which regulates the body's fluid content. If the vasopressin is successful in stopping urine production, this indicates that the diabetes insipidus is caused by a vasopressin deficiency, meaning the patient has cranial diabetes insipidus. In the cranial form of the condition, brain structures that make and store vasopressin are affected. Imaging studies of the brain such as a CT scan or MRI scan are used to look for any structural damage to the hypothalamus (where ADH is made) or pituitar Continue reading >>
Diabetes Insipidus (di) Vs Siadh Syndrome Of Inappropriate Antidiuretic Hormone Nclex Review
SIADH vs Diabetes Insipdius! Are you studying diabetes insipidus and SIADH and find it very confusing discerning between the two disease processes? You are not alone! 1 Weight Management Goals - Frequently Asked Questions Review Common Questions & Answers About a Prescription Obesity Treatment. Prescription treatment website 2 Start Download - View PDF Convert From Doc to PDF, PDF to Doc Simply With The Free Online App! download.fromdoctopdf.com In this article, I am going to easily break down the differences between diabetes insipidus (DI) and SIADH (Syndrome of Inappropriate Anti-diuretic Hormone). I addition, I provide a lecture on how to remember the differences between the two! Don’t forget to take the SIADH vs Diabetes Insipidus Quiz. What is Diabetes Insipidus and SIADH? This is where the body has a problem producing ADH (either too much or not enough). What is ADH? It is anti-diuretic hormone. This hormone is produced in the hypothalamus, and stored and eventually released in the posterior pituitary gland. In order to understand diabetes insipidus and SIADH, you MUST understand how ADH works because ADH plays an important role in both DI an SIADH. Lecture on SIADH and DI Key Points to Remember about SIADH and DI Each condition is related the secretion of ADH (anti-diuretic hormone also called vasopressin) which plays a major role in how the body RETAINS water. Each condition presents oppositely of each other (ex: in SIADH the patient retains water vs. DI where the patient loses water)—-Remember they are opposite of each other! Diabetes Insipidus and Diabetes Mellitus are two separate conditions and are not related although they share the name “Diabetes”. How does the Anti-diuretic Hormone work? ADH is produced in the hypothalamus and secreted/stored by t Continue reading >>
Diabetes Insipidus: A Challenging Diagnosis With New Drug Therapies
ISRN Nephrology Volume 2013 (2013), Article ID 797620, 7 pages Division of Nephrology, Department of Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA Academic Editors: M. Léone and D. Malhotra Copyright © 2013 Chadi Saifan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Diabetes Insipidus (DI) is either due to deficient secretion of arginine vasopressin (central) or to tubular unresponsiveness (nephrogenic). Drug induced DI is a well-known entity with an extensive list of medications. Polyuria is generally defined as urine output exceeding 3 liters per day in adults. It is crucial to identify the cause of diabetes insipidus and to implement therapy as early as possible to prevent the electrolyte disturbances and the associated mortality and morbidity. It is very rare to have an idiosyncratic effect after a short use of a medication, and physicians should be aware of such a complication to avoid volume depletion. The diagnosis of diabetes insipidus is very challenging because it relies on laboratory values, urine output, and the physical examination of the patient. A high clinical suspicion of diabetes insipidus should be enough to initiate treatment. The complications related to DI are mostly related to the electrolyte imbalance that can affect the normal physiology of different organ systems. 1. Background Though it is a rare disorder, diabetes insipidus was first described in the 18th century [1]. Diabetes insipidus (DI) is either due to deficient secretion of arginine vasopressin (AVP), also known as antidiuretic hormone (ADH) by the pitu Continue reading >>
What Is The Difference Between Diabetes Insipidus And Diabetes Mellitus?
The two types of diabetes, diabetes insipidus and diabetes mellitus differ in many ways. Though they share common name, ‘diabetes’, the reasons behind them and most of the symptoms are different. Diabetes mellitus is the most common of the two, as it is a lifestyle disease that affects metabolism in our body. The increased incidence of sedentary life, tensions, and decrease in physical activity are mostly to be blamed, though some other reasons such as auto-immune disease also are causes. Some severe head injuries, tumours, or certain diseases can result in diabetes insipidus. Here is more about diabetes insipidus and diabetes mellitus and the differences between them. What is diabetes insipidus? Due to some injuries or viral diseases, the hypothalamus or pituitary gland get damaged and might be rendered unable to produce the hormone vasopressin. In some, the kidneys might have defect or be damaged due to certain reasons resulting in inability to respond to vasopressin. This lack of vasopressin or inability to respond to vasopressin causes the body to lose water through excessive urination. This is known as diabetes insipidus. What is diabetes mellitus? Diabetes mellitus varies from diabetes insipidus mainly in the hormone involved. When it comes to diabetes mellitus, the hormone involved is insulin, secreted by pancreas, which is absorbed by the cells in our body as a message to use glucose present in the blood. When pancreas is unable to secrete insulin or when the cells in our body develop resistance to insulin, the glucose in the blood will not be utilized. This is known as diabetes mellitus. What are the differences between Diabetes Insipidus and Diabetes Mellitus? The Hormones Involved In diabetes insipidus, it is the lack of vasopressin or inability of kidney Continue reading >>
Diabetes Insipidus
Diabetes insipidus is a condition in which your ability to control the balance of water within your body is not working properly. Your kidneys are not able to retain water and this causes you to pass large amounts of urine. Because of this, you become more thirsty and want to drink more. There are two different types of diabetes insipidus: cranial and nephrogenic. Cranial diabetes insipidus may only be a short-term problem in some cases. Treatment includes drinking plenty of fluids so that you do not become lacking in fluid in the body (dehydrated). Treatment with medicines may also be needed for both types of diabetes insipidus. A note about thirst and water balance in your body Getting the balance right between how much water your body takes in and how much water your body passes out is very important. This is because a large proportion (about 70%) of your body is actually water. Also, water levels in your body help to control the levels of some important salts, particularly sodium and potassium. Your body normally controls (regulates) water balance in two main ways: By making you feel thirsty and so encouraging you to drink and take more water in. Through the action of a chemical (hormone) called antidiuretic hormone (ADH) which controls the amount of water passed out in your urine. ADH is also known as vasopressin. It is made in a part of your brain called the hypothalamus. It is then transported to another part of your brain, the pituitary gland, from where it is released into your bloodstream. After its release, ADH has an effect on your kidneys. It causes your kidneys to pass out less water in your urine (your urine becomes more concentrated). So, if your body is lacking in fluid (dehydrated), your thirst sensation will be triggered, encouraging you to drink. As Continue reading >>
Coexistence Of Diabetes Insipidus And Diabetes Mellitus In A Seven Year Old Girl
The occurrence of diabetes mellitus and diabetes insipidus in the same patient is rare. Greene and Gibson1 reviewed the literature to 1939 and found a total of 20 cases. As these authors pointed out, however, the diagnosis in many of these is questionable, owing to inadequate laboratory studies. They described an additional case of their own. Since that time, 6 more cases have been reported in the available literature.2 Of the 27 cases, only 2 have been of patients within the pediatric age group: a 13 year old boy studied by Mouriquand, Dauvergne and Monnet2d and a 14 year old boy reported on by Allan and Rowntree.3 The possibility that a single lesion may cause both diseases or that their association is purely coincidental has been discussed in several of the reports. The present case is of interest because of the uncommonness of the condition and Continue reading >>
