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Central Diabetes Insipidus Vs Nephrogenic Diabetes Insipidus

Diabetes Insipidus: Causes, Symptoms And Treatment

Diabetes Insipidus: Causes, Symptoms And Treatment

Diabetes insipidus is a condition where the body loses too much fluid through urination, causing a significant risk of dangerous dehydration as well as a range of illnesses and conditions. There are two forms of the disease: nephrogenic diabetes insipidus and central diabetes insipidus (also known as neurogenic diabetes insipidus). A number of factors have been linked to the development of diabetes insipidus, which may also occur in pregnancy or with the use of certain medications. Establishing the cause of the problem can help determine the most appropriate treatment to support the regulation of water balance in the body. Diabetes insipidus is a condition that can be managed successfully. Contents of this article: What is diabetes insipidus? An uncommon condition, diabetes insipidus is a disorder affecting the regulation of body fluid levels. Two key symptoms resemble those of the more common forms of diabetes that affect blood sugar levels (diabetes mellitus types 1 and 2).1-5 People with diabetes insipidus produce excessive amounts of urine (polyuria), resulting in frequent urination and, in turn, thirst (polydipsia). However, the underlying cause of these two symptoms is quite different from the causes in types 1 and 2 diabetes. In diabetes mellitus, elevated blood sugar prompts the production of large volumes of urine to help remove the excess sugar from the body. In diabetes insipidus, it is the body's water balance system itself that is not working properly. Here are some key points about diabetes insipidus. More detail and supporting information is in the body of this article. Diabetes insipidus is a condition where the body fails to properly control water balance, resulting in excessive urination. Diabetes insipidus can be caused by low or absent secretion of t Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Diabetes insipidus (DI) is an uncommon condition with either relative or absolute lack of anti-diuretic hormone (ADH) leading to inability to concentrate the urine and subsequent polyuria/polydypsia and potentially fluid and electrolyte imbalance. This can be seen in a variety of conditions in the paediatric population, most commonly in patients post neurosurgery or with cerebral malformations. Consideration should be given to: Hydration status/fluid balance/urine output Presence of intercurrent illness eg UTI Causes of excess fluid loss eg gastro, surgical drains Past history of DI with similar episode Change in weight as marker of fluid status Baseline investigations should include urea and electrolytes, full ward test of urine and paired serum and urine osmolality. Diabetes insipidus is present when the serum osmolality is raised (>295milliOsmol/kg) with inappropriately dilute urine (urine osmolality < 700milliOsmol/kg). The serum sodium is often elevated due to excess free water losses. After assessment of level of dehydration and ongoing losses, adequate rehydration therapy should be commenced. If the serum Na is > 150mmol/L, rehydration should occur over 48 hours (see hypernatraemia guideline). If Na >170mmol/L, contact ICU. Discussion with the endocrinologist on call is advised prior to the commencement of Desmopressintherapy Desmopressin (DDAVP, trade name: Minirin(R)) acts on the distal tubules and collecting ducts of the kidney to increase water reabsorption, as a long acting analog of anti-diuretic hormone (ADH). There are several formulations available: Intranasal solution - 100 micrograms/mL Intranasal spray (10 micrograms/spray) Parenteral (IM/IM) - 4 micrograms/ml - used rarely Oral - 200 micrograms/tablets (roughly 10 micrograms intranasal is approximate Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Practice Essentials Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms: Two other forms are gestational DI and primary polydipsia (dipsogenic DI); both are caused by deficiencies in AVP, but the deficiencies do not result from a defect in the neurohypophysis or kidneys. Signs and symptoms The predominant manifestations of DI are as follows: The most common form is central DI after trauma or surgery to the region of the pituitary and hypothalamus, which may exhibit 1 of the following 3 patterns: In infants with DI, the most apparent signs may be the following: In children, the following manifestations typically predominate: If the condition that caused DI also damaged the anterior pituitary or hypothalamic centers that produce releasing factors, patients may present with the following: Physical findings vary with the severity and chronicity of DI; they may be entirely normal or may include the following: See Clinical Presentation for more detail. If the clinical presentation suggests DI, laboratory tests must be performed to confirm the diagnosis, as follows: Additional studies that may be indicated include the following: See Workup for more detail. Management Most patients with DI can drink enough fluid to replace their urine losses. When oral intake is inadequate and hypernatremia is present, provide fluid replacement as follows: Give dextrose and water or an intravenous fluid that is hypo-osmolar with respect to the patient’s serum; do not administer sterile water without dextrose IV Administer fluids at a rate no greater than 500-750 mL/hr; aim at reducing serum sodium by approximately 0.5 mmol/L (0.5 mEq/L) every hour Pharmacologic therapeutic options include the follo Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Diabetes insipidus (DI) is a condition characterized by large amounts of dilute urine and increased thirst.[1] The amount of urine produced can be nearly 20 liters per day.[1] Reduction of fluid has little effect on the concentration of the urine.[1] Complications may include dehydration or seizures.[1] There are four types of DI, each with a different set of causes.[1] Central DI (CDI) is due to a lack of the hormone vasopressin (antidiuretic hormone).[1] This can be due to damage to the hypothalamus or pituitary gland or genetics.[1] Nephrogenic diabetes insipidus (NDI) occurs when the kidneys do not respond properly to vasopressin.[1] Dipsogenic DI is due to abnormal thirst mechanisms in the hypothalamus while gestational DI occurs only during pregnancy.[1] Diagnosis is often based on urine tests, blood tests, and the fluid deprivation test.[1] Diabetes mellitus is a separate condition with an unrelated mechanism, though both can result in the production of large amounts of urine.[1] Treatment involves drinking sufficient fluids to prevent dehydration.[1] Other treatments depend on the type.[1] In central and gestational disease treated is with desmopressin.[1] Nephrogenic disease may be treated by addressing the underlying cause or the use of a thiazide, aspirin, or ibuprofen.[1] The number of new cases of diabetes insipidus each year is 3 in 100,000.[4] Central DI usually starts between the ages of 10 and 20 and occurs in males and females equally.[2] Nephrogenic DI can begin at any age.[3] The term "diabetes" is derived from the Greek word meaning siphon.[5] Signs and symptoms[edit] Excessive urination and extreme thirst and increased fluid intake (especially for cold water and sometimes ice or ice water) are typical for DI.[6] The symptoms of excessive urination Continue reading >>

Nephrogenic Diabetes Insipidus

Nephrogenic Diabetes Insipidus

Nephrogenic diabetes insipidus (NDI) is an inability to concentrate urine due to impaired renal tubule response to vasopressin (ADH), which leads to excretion of large amounts of dilute urine. It can be inherited or occur secondary to conditions that impair renal concentrating ability. Symptoms and signs include polyuria and those related to dehydration and hypernatremia. Diagnosis is based on measurement of urine osmolality changes after water deprivation and administration of exogenous vasopressin. Treatment consists of adequate free water intake, thiazide diuretics, NSAIDs, and a low-salt, low-protein diet. NDI is characterized by inability to concentrate urine in response to vasopressin. Central diabetes insipidus is characterized by lack of vasopressin. Either type of diabetes insipidus may be complete or partial. Acquired NDI Acquired NDI can occur when disorders (many of which are tubulointerstitial diseases) or drugs disrupt the medulla or distal nephrons and impair urine concentrating ability, making the kidneys appear insensitive to vasopressin. These disorders include the following: Acquired NDI can also be idiopathic. A mild form of acquired NDI can occur in any patient who is elderly or sick or who has acute or chronic renal insufficiency. NDI is suspected in any patient with polyuria. In infants, polyuria may be noticed by the caregivers; if not, the first manifestation may be dehydration. Initial testing includes 24-h urine collection (without fluid restriction) for volume and osmolality, and serum electrolytes. Patients with NDI excrete > 50 mL/kg of urine/day (polyuria). If urine osmolality is < 300 mOsm/kg (water diuresis), central diabetes insipidus or NDI is likely. With NDI, urine osmolality is typically < 200 mOsm/kg despite clinical signs of hypov Continue reading >>

Diabetes Insipidus - Endocrine - Medbullets Step 1

Diabetes Insipidus - Endocrine - Medbullets Step 1

This patient is suffering from diabetes insipidus (DI). In a standard desmopressin test, an increase in urine osmolality of greater than 10% is highly suggestive of a diagnosis of central DI. Central DI is characterized by the failure of the hypothalamic-pituitary axis to produce and secrete sufficient levels of the hormone vasopressin (ADH). A desmopressin test is a highly useful diagnostic tool to differentiate between central (described above) and nephrogenic (resistance to ADH action in the kidneys) DI. The test involves injection of exogenous vasopressin. In central DI, injection of exogenous vasopressin will act to rectify the inappropriately low levels of endogenous ADH, leading to an increase in urine osmolality towards the normal range. In contrast, injection of ADH in the setting of nephrogenic ADH will not have any notable effect, as increasing ADH levels will not overcome the disease mechanism of renal resistance to ADH action. Adam describes the diagnostic protocol of DI in which the desmopressin test can help distinguish neurogenic from nephrogenic cases of DI. The treatment of neurogenic DI may involve nasal administration of desmopressin while nephrogenic DI requires hydration and the administration of thiazides and amiloride. Thompson et al. describe the normal physiological action of ADH, which is to recruit aquaporin channels in the renal distal tubules and collecting ducts, leading to increased reabsorption of water and an improved ability to excrete concentrated urine. Thus, both forms of diabetes insipidus manifest with symptoms of dehydration and inappropriate excretion of excessive volumes of dilute urine. Illustration A depicts urine osmolality and response to water deprivation and desmopressin test in both central and nephrogenic DI. Answer 1 Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

On this page: What is diabetes insipidus? Diabetes insipidus is a rare disorder that occurs when a person's kidneys pass an abnormally large volume of urine that is insipid—dilute and odorless. In most people, the kidneys pass about 1 to 2 quarts of urine a day. In people with diabetes insipidus, the kidneys can pass 3 to 20 quarts of urine a day. As a result, a person with diabetes insipidus may feel the need to drink large amounts of liquids. Diabetes insipidus and diabetes mellitus—which includes both type 1 and type 2 diabetes—are unrelated, although both conditions cause frequent urination and constant thirst. Diabetes mellitus causes high blood glucose, or blood sugar, resulting from the body's inability to use blood glucose for energy. People with diabetes insipidus have normal blood glucose levels; however, their kidneys cannot balance fluid in the body. What are the kidneys and what do they do? The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys normally filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. How is fluid regulated in the body? A person's body regulates fluid by balancing liquid intake and removing extra fluid. Thirst usually controls a person’s rate of liquid intake, while urination removes most fluid, although people also lose fluid through sweating, breathing, or diarrhea. The hormone vasopressin, also called antidiuretic hormone, con Continue reading >>

Central Diabetes Insipidus

Central Diabetes Insipidus

OVERVIEW diabetes insipidus is a condition caused by loss of the effect of antidiuretic hormone on the collecting ducts of the kidneys, resulting in loss of free water. diabetes insipidus can be central or nephrogenic This article will focus on CDI PATHOPHYSIOLOGY Normal physiology ADH is produced in the hypothalamus and travels along nerve fibers to the posterior pituitary, where it is stored and released Increased plasma osmolality stimulates release of ADH ADH promotes reabsorption of water in the collecting duct of nephrons via translocation of aquaporins (water channels) to the plasma membrane from internal sites within the cells Diabetes insipidus central DI (CDI) results from causes that impair the synthesis, transport, or release of ADH nephrogenic DI (NDI) results from receptor, or downstream, unrepsonsiveness to circulating ADH loss of ADH effect results in polyuria, dehydration, hypernatremia and a hyperosmolar state CAUSES OF CENTRAL DIABETES INSIPIDUS Acquired Surgery (transsphenoidal) – common TBI – common Idiopathic Autoimmune Tumours (suprasellar, lung, breast, lymphoma, leukaemia) Hypoxic brain injury Brain stem death Profound hyponatraemia -> cerebral oedema Radiotherapy Inflammatory conditions – sickle cell, sarcoid, Wegener’s, histiocytosis X Infections – Tb, abscess, encephalitis, meningitis Vascular disease – CVA, SAH, Sheehan’s syndrome, pituitary apoplexy Congenital Autosomal dominant mutation in ADH production Wolfram syndrome DIAGNOSIS Key findings plasma hyperosmolality (can be mild in partial DI) hypernatraemia (na >155 mM) polyuria (>3L/24h) urine osmolality < 200 mOsm/kg Water deprivation test rarely performed in the critical care setting usually 4-18h water deprivation with serial urine and plasma osmolality until: — 5% los Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Print Overview Diabetes insipidus (die-uh-BEE-teze in-SIP-uh-dus) is an uncommon disorder that causes an imbalance of water in the body. This imbalance leads to intense thirst even after drinking fluids (polydipsia), and excretion of large amounts of urine (polyuria). While the names diabetes insipidus and diabetes mellitus sound similar, they're not related. Diabetes mellitus — which can occur as type 1 or type 2 — is the more common form of diabetes. There's no cure for diabetes insipidus, but treatments are available to relieve your thirst and normalize your urine output. Symptoms The most common signs and symptoms of diabetes insipidus are: Extreme thirst Excretion of an excessive amount of diluted urine Depending on the severity of the condition, urine output can be as much as 16 quarts (about 15 liters) a day if you're drinking a lot of fluids. Normally, a healthy adult will urinate an average of less than 3 quarts (about 3 liters) a day. Other signs may include needing to get up at night to urinate (nocturia) and bed-wetting. Infants and young children who have diabetes insipidus may have the following signs and symptoms: Unexplained fussiness or inconsolable crying Trouble sleeping Fever Vomiting Diarrhea Delayed growth Weight loss When to see a doctor See your doctor immediately if you notice the two most common signs of diabetes insipidus: excessive urination and extreme thirst. Causes Diabetes insipidus occurs when your body can't regulate how it handles fluids. Normally, your kidneys remove excess body fluids from your bloodstream. This fluid waste is temporarily stored in your bladder as urine, before you urinate. When your fluid regulation system is working properly, your kidneys conserve fluid and make less urine when your body water is decreased, suc Continue reading >>

Medical Definition Of Diabetes Insipidus

Medical Definition Of Diabetes Insipidus

Diabetes insipidus: Excessive urination and extreme thirst as a result of inadequate output of the pituitary hormone ADH (antidiuretic hormone, also called vasopressin) or the lack of the normal response by the kidney to ADH. There are two types of diabetes insipidus -- central and nephrogenic. Central diabetes insipidus is a lack of ADH production and is due to damage to the pituitary gland or hypothalamus where ADH is produced. Nephrogenic diabetes insipidus is lack of response of the kidney to the fluid-conserving action of ADH. Nephrogenic diabetes insipidus can be due to diseases of the kidney (such as polycystic kidney disease), certain drugs (such as lithium), and can also occur an inherited disorder. In both central and nephrogenic diabetes insipidus, patients excrete extraordinarily large volumes of very dilute urine. They feel thirsty and drink very large amounts of water to compensate for the water they lose in the urine. The main danger with diabetes insipidus comes when fluid intake does not keep pace with urine output, resulting in dehydration and high blood sodium. The treatment of central diabetes insipidus is with vasopressin used as a nasal spray or as tablets. Nephrogenic diabetes insipidus does not respond to vasopressin treatment. In cases of nephrogenic diabetes insipidus caused by a drug (such as lithium), stopping the drug usually leads to recovery. In cases of hereditary nephrogenic diabetes insipidus, treatment is with fluid intake to match urine output and drugs that lower urine output. Effective treatment is important because the dehydration and high blood sodium can cause brain damage and death. Last Editorial Review: 5/13/2016 Continue reading >>

Neurogenic Vs. Nephrogenic Diabetesinsipidus

Neurogenic Vs. Nephrogenic Diabetesinsipidus

What is the difference between nephrogenic and neurogenic diabetes insipidus? Nephrogenic diabetes insipidus is from the word nephro meaning kidneys. This indicates that the cause of the increase in urine output is due to a problem in the kidney. In diabetes insipidus, more than 2.5 liters of urine is excreted per day. The excretion of urine is controlled by the amount of anti-diuretic hormone (ADH) released from the hypothalamus. In nephrogenic DI, the level of ADH in the body is normal to high. ADH levels may rise in order for the body to compensate the increased excretion of water, but because the kidneys are damaged, response to ADH stimulation is diminished. The diminished response of the kidneys to ADH stimulation may be due to renal resistance or receptor damage. On the other hand, neurogenic DI is from the word neuro meaning brain. In central or neurogenic DI, the problem lies in the gland secreting the hormone, which is the hypothalamus. There is decreased or absence of ADH secretion, therefore little or no stimulation occurs in the kidneys. As a result, large amount of water is excreted in the urine. Differentiation between nephrogenic and central DI may be done with the water deprivation test. The bodys response to the administration of exogenous ADH (or vasopressin) distinguishes between the two. In nephrogenic DI, there will be little to no response to the administration of ADH. This is because the damage is in the kidneys. No matter how much ADH is given, the kidneys are simply not healthy enough to recognize the stimulation and will continue to excrete water. In contrast, central DI is associated with low levels of ADH. If ADH is administered, the kidney quickly responds and reabsorbs water. Remember that in central DI, the kidneys are normal and functio Continue reading >>

Central Diabetes Insipidus

Central Diabetes Insipidus

is completely unrelated to diabetes, even though they share the symptoms of peeing more and feeling thirsty. It's also called "central DI," "pituitary DI," "hypothalamic DI," "neurohypophyseal DI," or "neurogenic DI." Central DI is much less common than diabetes, and treatments for the two diseases are different. The key sign of central diabetes insipidus is extreme thirst and excessive urination. The disease happens when the body doesn't make enough of the hormone vasopressin, which controls how much urine the kidneys put out. Without vasopressin, the kidneys can't work properly. As a result, the body loses a lot of water, quickly, in diluted urine. This makes people very thirsty, so they drink lots of water. Anyone can get central DI, but it's not common. Only about 1 in every 25,000 people gets it. In about half the cases, doctors don't know what causes central DI. Other times, it happens because of damage or injury to the hypothalamus or pituitary gland. This damage can be due to surgery, head trauma, tumor, inflammation, or infection. In very rare cases, genetic defects are the cause. Prompt treatment of injuries, infections, and tumors can lower the odds of getting the disease. People with central DI usually have the following symptoms: Frequent urination -- more than 3 liters of urine a day Frequent nighttime awakening to pee Involuntary urination during sleep (bed-wetting) Pale, colorless urine Low measured concentration of urine Extreme thirst -- often drinking more than 1 gallon of liquid per day In severe cases, or if a person can't get enough liquid to drink, central diabetes insipidus can cause: Confusion Loss of consciousness Symptoms of central DI in children may be: Low energy Irritability Slow growth Fever A checkup may not show any signs of central DI, Continue reading >>

Diagnosis Of Polyuria And Diabetes Insipidus

Diagnosis Of Polyuria And Diabetes Insipidus

DEFINITION Polyuria has generally been defined as a urine output exceeding 3 L/day in adults and 2 L/m2 in children. It must be differentiated from the more common complaints of frequency or nocturia, which are not associated with an increase in the total urine output. The following is an overview of the diagnosis of polyuria and diabetes insipidus (DI). The causes and treatment of polyuria due to central or nephrogenic DI are presented separately. (See "Clinical manifestations and causes of central diabetes insipidus" and "Clinical manifestations and causes of nephrogenic diabetes insipidus" and "Treatment of central diabetes insipidus" and "Treatment of nephrogenic diabetes insipidus".) CAUSES In the absence of a glucose-induced osmotic diuresis in uncontrolled diabetes mellitus, there are three major causes of polyuria in the outpatient setting, each of which is due to a defect in water balance leading to the excretion of large volumes of dilute urine (urine osmolality usually below 250 mosmol/kg): primary polydipsia, which is primarily seen in adults and adolescents; central DI; and nephrogenic DI [1]. Primary polydipsia — Primary polydipsia (sometimes called psychogenic polydipsia) is characterized by a primary increase in water intake. This disorder is most often seen in middle-aged women and in patients with psychiatric illnesses, including those taking a phenothiazine, which can lead to the sensation of a dry mouth. Primary polydipsia can also be induced by hypothalamic lesions that directly affect the thirst center, as may occur with an infiltrative disease such as sarcoidosis [1]. (See "Causes of hyponatremia in adults".) Central DI — Central DI (also called neurohypophyseal or neurogenic DI) is associated with deficient secretion of antidiuretic hormone ( Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Central diabetes insipidus is caused by reduced secretion of antidiuretic hormone (ADH). When target cells in the kidney lack the biochemical machinery necessary to respond to the secretion of normal or increased circulating levels of ADH, nephrogenic diabetes insipidus results. It occurs infrequently in dogs, cats, and laboratory rats, and rarely in other animals. Etiology: The hypophyseal form develops as a result of compression and destruction of the pars nervosa, infundibular stalk, or supraoptic nucleus in the hypothalamus. The lesions responsible for the disruption of ADH synthesis or secretion in hypophyseal diabetes insipidus include large pituitary neoplasms (endocrinologically active or inactive), a dorsally expanding cyst or inflammatory granuloma, and traumatic injury to the skull with hemorrhage and glial proliferation in the neurohypophyseal system. Clinical Findings: Affected animals excrete large volumes of hypotonic urine and drink equally large amounts of water. Urine osmolality is decreased below normal plasma osmolality (~300 mOsm/kg) in both hypophyseal and nephrogenic forms, even if the animal is deprived of water. The increase of urine osmolality above that of plasma in response to exogenous ADH in the hypophyseal form, but not in the nephrogenic form, is useful in the clinical differentiation of the two forms of the disease. Lesions: The posterior lobe, infundibular stalk, and hypothalamus are compressed or disrupted by neoplastic cells. This interrupts the nonmyelinated axons that transport ADH from its site of production (hypothalamus) to its site of release (pars nervosa). Diagnosis: This is based on chronic polyuria that does not respond to dehydration and is not due to primary renal disease. To evaluate the ability to concentrate urine, a wa Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

During the day, your kidneys filter all your blood many times. Normally, most of the water is reabsorbed, and only a small amount of concentrated urine is excreted. DI occurs when the kidneys cannot concentrate the urine normally, and a large amount of dilute urine is excreted. The amount of water excreted in the urine is controlled by antidiuretic hormone (ADH). ADH is also called vasopressin. ADH is produced in a part of the brain called the hypothalamus. It is then stored and released from the pituitary gland. This is a small gland just below the base of the brain. DI caused by a lack of ADH is called central diabetes insipidus. When DI is caused by a failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus. Nephrogenic means related to the kidney. Central DI can be caused by damage to the hypothalamus or pituitary gland as a result of: Head injury Infection Loss of blood supply to the pituitary gland Surgery Nephrogenic DI involves a defect in the kidneys. As a result, the kidneys do not respond to ADH. Like central DI, nephrogenic DI is very rare. Nephrogenic DI may be caused by: Certain drugs, such as lithium Genetic problems Continue reading >>

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