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 >>
How Is Diabetes Insipidus Diagnosed?
To see if you have diabetes insipidus, your doctor will do a series of blood and urine tests that may take several hours. You'll go without water the whole time, so you'll get thirstier. Your doctor will measure the sodium in your blood and urine. He may give you an ADH substitute to see if your kidneys respond by concentrating your urine. The lab test results and your response to the ADH will help the doctor make the call. Continue reading >>
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Diabetes Insipidus
Alternative names for diabetes insipidus Water diabetes; DI What is diabetes insipidus? Anti-diuretic hormone (also called vasopressin) is produced in the hypothalamus and then secreted by the pituitary gland into the bloodstream at the base of the brain. Anti-diuretic hormone is needed to stop the kidneys from producing too much urine. There are two types of diabetes insipidus, cranial and nephrogenic. Cranial diabetes insipidus is a condition in which the hypothalamus does not produce enough anti-diuretic hormone. Nephrogenic diabetes insipidus is a condition in which the kidneys fail to respond to anti-diuretic hormone. Both conditions mean that the kidneys are unable to retain water, leading to the passing of too much dilute urine (pale urine). This occurs even when the body is dehydrated and should be trying to save fluid by producing concentrated urine (dark urine). What causes diabetes insipidus? Usually diabetes insipidus is thought to have no clear, definable cause. This is known as idiopathic. However, some causes can be found: In cranial diabetes insipidus, the brain produces little or no anti-diuretic hormone. This can be as a result of: head injuries, pituitary tumours or neurosurgery (in these patients, diabetes insipidus may only be short-term) conditions that spread through the body (known as infiltrating) such as haemochromatosis and sarcoidosis infections such as tuberculosis genetic defects (very rare). In nephrogenic diabetes insipidus, the brain is producing enough anti-diuretic hormone but the kidneys are insensitive to it and are unable to produce urine that is dark enough. The causes may be, for example, amyloidosis, polycystic kidneys, medications such as lithium and, very rarely, inherited genetic disorders. Gestational diabetes insipidus – t Continue reading >>
Diagnosing Diabetes Insipidus In Dogs
Initial Evaluation The physical examination findings of dogs with diabetes insipidus are generally normal or unremarkable. The results of routine blood work (a complete blood count and serum biochemistry profile) may or may not be helpful. However, a urinalysis will usually show abnormally dilute, or unconcentrated, urine. In medical lingo, this is referred to as low urine specific gravity, or “isosthenuria”. Culturing a urine sample, conducting a blood test for Cushing’s disease (hyperadrenocorticism) and conducting abdominal ultrasound, may all be helpful to rule in or out a number of causes of nephrogenic diabetes insipidus. Diagnostic Procedures Advanced diagnostic tools and procedures can help differentiate between central or nephrogenic diabetes insipidus on the one hand (CDI or NDI), and psychogenic or idiopathic polydipsia on the other. These may include assessment of the dog’s clearance of creatinine, assessment of something called plasma osmolality and a procedure called nuclear scintigraphy. A modified water deprivation test can be performed, but it must be done extremely carefully, under strict veterinary supervision and only on dogs that are properly hydrated and do not have kidney disease. The water deprivation test requires hourly monitoring that is rigidly adhered to, and should be done in a veterinary hospital. Computed tomography (CT scan) and magnetic resonance imaging (MRI) can be used to identify masses or other physical abnormalities in the pituitary gland and hypothalamus. All of these advanced diagnostic techniques should be discussed in much greater detail with a veterinarian. Sometimes, administering a synthetic version of antidiuretic hormone (ADH), which is called desmopressin acetate, or DDAVP, in a therapeutic ADH supplementation tr Continue reading >>
Diabetes Insipidus
Diabetes insipidus (DI) causes frequent urination. You become extremely thirsty, so you drink. Then you urinate. This cycle can keep you from sleeping or even make you wet the bed. Your body produces lots of urine that is almost all water. DI is different from diabetes mellitus (DM), which involves insulin problems and high blood sugar. The symptoms can be similar. However, DI is related to how your kidneys handle fluids. It's much less common than DM. Urine and blood tests can show which one you have. Usually, DI is caused by a problem with your pituitary gland or your kidneys. Treatment depends on the cause of the problem. Medicines can often help. NIH: National Institute of Diabetes and Digestive and Kidney Diseases Continue reading >>
Diabetes Insipidus Lab Values Explained
Only a laboratory testing is able to confirm the presence of diabetes insipidus. These tests in some form have been available in the United States since the 1930s. If the clinical presentation of this condition is suggested by the signs and symptoms being suffered, then a medical provider will order a 24 hour urine collection to determine how much volume is being passed through the body. There are also certain measurements that are typically performed at the laboratory as the volume of urine is being considered. This includes glucose levels, serum electrolytes, urinary specific gravity, ADH levels, and plasma/urinary osmolality. Testing is most accurate when the patient can be as dehydrated as the can tolerate. This will allow the anti-diuretic hormone ADH to be at its highest concentrated levels for the testing period. Even water deprivation may be considered as part of the testing process if it can be safely performed and the diagnosis is uncertain. Once the 24 hour urine collection period has been evaluated, the laboratory will come back with results that are communicated through the medical provider. Here are those diabetes insipidus lab values explained. What Do the Diabetes Insipidus Lab Values Mean? There are two hallmarks that will confirm the presence of diabetes insipidus. The first is the measurement of specific gravity. If the urine has a specific gravity of 1,005 or less, then this can indicate the presence of this health condition. Urinary osmolality that is less than 200 mOsm/kg is also a strong indicator of the presence of diabetes insipidus. The average plasma osmolality on a random patient test is 287 mOsm/kg of water. If there are large volumes of urine that is very dilute or clear, then this can be a visual indicator that these testing values may be Continue reading >>
Diabetes Insipidus In Dogs
What is Diabetes insipidus? There are two types of diabetes in dogs. Diabetes mellitus (DM) is also called “sugar diabetes” and results from a disruption of pancreas function and abnormal regulation of blood sugar. The term, meaning “sweetened with honey,” originated from the fact that the urine of these patients was “sweet” due to high amounts of sugar excreted from the body. Diabetes insipidus (DI) gets its name from the fact that the urine of these patients is dilute enough to be “tasteless” or “insipid.” Diabetes insipidus (DI) is rare in dogs, and is characterized by excessive thirst/drinking and the production of enormous volumes of extremely dilute urine. Some dogs may produce so much urine that they become incontinent (incapable of controlling their urine outflow). The irony of this disease is that despite drinking large volumes of water, the dog can become dehydrated from urinating so much. My dog is drinking and urinating a lot. Is DI the likely cause? There are many causes of increased thirst (polydipsia) and increased urine production (polyuria), including diabetes insipidus, diabetes mellitus, liver problems, and kidney disease, to name a few. It is essential that several diagnostic tests be performed to determine the cause of your dog’s problem. How is DI diagnosed? Part of diagnosing DI involves first eliminating other potential explanations for increased drinking and increased urinating. Typical laboratory testing will include a complete blood count (CBC), blood chemistry panel to evaluate liver and kidney parameters and blood sugar, and a urinalysis. The urine concentration (specific gravity) is quite low in these dogs. A more advanced test involves calculating normal daily water intake, measuring how much the dog is truly drinking Continue reading >>
Central Diabetes Insipidus
(Vasopressin-Sensitive Diabetes Insipidus) By Ian M. Chapman, MBBS, PhD, Professor of Medicine, Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital Central diabetes insipidus is a lack of the hormone vasopressin (antidiuretic hormone) that causes excessive production of very dilute urine (polyuria). Central diabetes insipidus has several causes, including a brain tumor, a brain injury, brain surgery, tuberculosis, and some forms of other diseases. The diagnosis is based on urine tests, blood tests, and a water deprivation test. Vasopressin is a hormone produced by the hypothalamus (a region of the brain that lies just above the pituitary) and stored in and released from the posterior lobe of the pituitary gland. Vasopressin helps regulate the amount of water in the body by signalling the kidneys to decrease the amount of urine they produce (see About Body Water). Because a diuretic is a substance that increases urine production, vasopressin previously was referred to as antidiuretic hormone. Causes Other disorders that can cause central diabetes insipidus include accidental damage done during surgery on the hypothalamus or pituitary gland; a brain injury, particularly a fracture of the base of the skull; a tumor; sarcoidosis or tuberculosis; an aneurysm (a bulge in the wall of an artery) or blockage in the arteries leading to the brain; some forms of encephalitis or meningitis; and the rare disease Langerhans cell histiocytosis. Nephrogenic diabetes insipidus is another type of diabetes insipidus in which there is an adequate amount of vasopressin, but abnormalities in the kidneys cause them not to respond to vasopressin. Symptoms Diagnosis Doctors suspect diabetes insipidus in people who produce large amounts of urine. They first test the urine for Continue reading >>
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 Panel
Test code: KI1801 The Blueprint Genetics Diabetes Insipidus Panel is a three gene test for genetic diagnostics of patients with clinical suspicion of nephrogenic diabetes insipidus. This panel covers genes associated with X-linked and autosomal recessive and dominant forms of the disease. About 90% of all cases of hereditary diabetes insipidus result from mutations in the AVPR2 gene. Most of the remaining cases are caused by mutations in the AQP2 gene. About Diabetes Insipidus Nephrogenic diabetes insipidus (NDI) is an early onset disorder (infancy/neonatal) of fluid imbalance, which is characterized by inability to concentrate the urine, which results in polyuria (excessive urine production) and polydipsia (excessive thirst). The disease results from the failure of the renal tubules to respond to antidiuretic hormone. Short stature and secondary dilatation of the ureters and bladder from the high urine volume is common in untreated individuals. Acute hypernatremic dehydration after birth that may cause neurological sequelae. Prevalence of NDI is estimated at 1-2:1,000,000 worldwide but in Quebec, Canada, the estimated prevalence is as high as 8:1,000,000 in males. When nephrogenic diabetes insipidus results from mutations in the AVPR2 gene, the condition has an X-linked recessive pattern of inheritance, which is in about 90 percent of all cases. Some females who carry a single mutated copy of the AVPR2 gene have features of nephrogenic diabetes insipidus. NDI caused by mutations in the AQP2 gene, can have either an autosomal recessive or an autosomal dominant pattern of inheritance. Both of these genes provide instructions for making proteins that help determine how much water is excreted in urine. Results in 3-4 weeks. We do not offer a maternal cell contamination (MC Continue reading >>
Diabetes Insipidus In Dogs
Diabetes insipidus (DI) is rare in dogs and is distinct from diabetes mellitus (DM). There are 2 types of DI and both are related to the pituitary gland. Your dog will most likely present with issues with urination frequency and amount of water intake. Other diagnoses may have to be ruled out due to their similar symptoms, some of those include diabetes mellitus, Cushing’s disease, renal failure, liver disease and infection of the uterus amongst others. Diabetes insipidus (DI) is an issue with your dog’s ability to control his water intake and urine output. This is a pituitary gland disorder that is rare in dogs and causes your dog’s urine to become diluted due to his inability to concentrate his urine and can lead to dehydration in your dog if left alone. Symptoms are quite simple to identify, however once again they are similar to other disorders and cannot be used solely to diagnose. Excessive urination (polyuria) Excessive drinking (polydipsia) It may appear that your dog has incontinence problems, however, it is probably the excessive urination he is experiencing Weight loss Failure to thrive Types There are two types of diabetes insipidus and both are directly related to the pituitary gland and how it interacts with the body. Central Diabetes Insipidus (CDI) Caused by the pituitary gland not releasing enough of the hormone called vasopressin which is an antidiuretic hormone May be due to birth defect, trauma, tumor on the pituitary gland, or possible unknown cause Found in any breed, gender and age of dog Can begin anywhere from 7 weeks to 14 years of age Nephrogenic Diabetes Insipidus (NDI) Caused by your dog’s kidneys not responding to vasopressin that the pituitary gland produces May be due to birth defect, drugs, other metabolic disorders Found more of Continue reading >>
Diabetes Insipidus
Types of diabetes insipidus Diabetes insipidus can be divided into four different types that are caused by any one of four fundamentally different defects (Fig. 5.1): 1. pituitary, central, neurogenic, or neurohypophyseal diabetes insipidus, the most common type, results from a deficiency in the production of the antidiuretic hormone arginine vasopressin (AVP); 2. renal or nephrogenic diabetes insipidus is caused by renal insensitivity to the antidiuretic effects of AVP, for example, due to impairment of the renal vasopressin V2 receptor or aquaporin-2 water channel; 3. primary polydipsia is due to suppression of AVP secretion as a result of excessive fluid intake. Depending on whether the excessive fluid intake is due to abnormal thirst or due to a psychological disorder, primary polydipsia is subdivided into, respectively, dipsogenic diabetes insipidus11,12 psychogenic diabetes insipidus,13,14 and 4. gestational diabetes insipidus,15–18 which is primarily due to increased metabolism of AVP by circulating vassopressinase produced by the placenta in the pregnant woman but may also involve renal resistance and/or subclinical deficiency in AVP production. Complete diabetes insipidus is defined by persistently low urine osmolality (<300 mosmol/kg) during a fluid deprivation test providing plasma osmolality rises above 295 mosmol/kg. Partial diabetes insipidus is defined by a subnormal increase in urine osmolality (300–600 mosmol/kg) during a fluid deprivation test with the same rise in plasma osmolality.4 Definition Diabetes insipidus (DI) is a heterogeneous condition characterized by polyuria and polydipsia caused either due to a lack of secretion of vasopressin (antidiuretic hormone) from posterior pituitary, its physiological suppression following excessive water in Continue reading >>
Diagnosis
Print Since the signs and symptoms of diabetes insipidus can be caused by other conditions, your doctor will perform a number of tests. If your doctor determines you have diabetes insipidus, he or she will need to determine which type of diabetes insipidus you have, because the treatment is different for each form of the disease. Some of the tests doctors commonly use to diagnose and determine the type of diabetes insipidus and in some cases, its cause, include: Water deprivation test. This test confirms the diagnosis and helps determine the cause of diabetes insipidus. Under medical supervision, you'll be asked to stop drinking fluids for a time so that your doctor can measure changes in your body weight, urine output and the concentration of your urine and blood when fluids are withheld. Your doctor may also measure blood levels of ADH or administer synthetic ADH during this test. The water deprivation test is performed under close supervision in children and pregnant women to make sure no more than 5 percent of body weight is lost during the test. Urinalysis. Urinalysis is the physical and chemical examination of urine. If your urine is less concentrated — meaning the amount of water is high relative to other excreted substances — it could be due to diabetes insipidus. Magnetic resonance imaging (MRI). An MRI of the head is a noninvasive procedure that uses a powerful magnetic field and radio waves to construct detailed pictures of brain tissues. Your doctor may want to perform an MRI to look for abnormalities in or near the pituitary gland. Genetic screening If your doctor suspects an inherited form of diabetes insipidus, he or she will look at your family history of polyuria and may suggest genetic screening. Treatment Treatment of diabetes insipidus depends on Continue reading >>
Diabetes Insipidus
Diagnosis and Treatment The diagnosis of diabetes insipidus is based on a series of tests, including a urine osmolality and water deprivation test. With diabetes insipidus, the urine is less concentrated with low salt and waste levels. The concentration of the urine can be tested by measuring osmolality, which is how many particles are in about a quart of water. A water deprivation test is a complicated procedure that requires specially trained medical professionals. It should be done in a controlled setting where the patient can be monitored closely throughout the entire test. The water deprivation test measures changes in body weight, urine output, and the make-up of the urine, and levels of salts in the blood when fluids are withheld and as dehydration occurs. Measuring blood levels of the hormone ADH is also usually performed. Samples are taken every hour over a several-hour period. An x-ray test called an MRI scan may be done to look for abnormalities in the pituitary gland, although alone, this is not diagnostic of diabetes insipidus. However, at diagnosis, it is estimated that 71% of patients show an abnormally thickened pituitary stalk on MRI. Diabetes insipidus can be corrected by giving a synthetic vasopressin called DDAVP, which works on the kidneys to help decrease the amount of urine made. A normal balance between water intake and urine output is usually quickly restored. Most patients receive DDAVP as a pill or spray into the nose. However, if this is not possible due to the age or condition of the patient, DDAVP can be given by injection. It may be given in the hospital, clinic, or home. The dosage and method of receiving this hormone will depend on each individual case and should be discussed with your physician. Fortunately, this treatment can be taken Continue reading >>
Diabetes Insipidus
Tweet Diabetes insipidus, often shortened to DI, is a rare form of diabetes that is not related to blood sugar-related diabetes mellitus, but does share some of its signs and symptoms. Diabetes insipidus is simply excessive urination (polyuria) and complications thereof, caused by an antidiuretice hormone called a vasopressin. Read on to find out more about what diabetes insipidus is, how it affects the body, the different forms of the disease, and how it is diagnosed and treated. What are the symptoms of diabetes insipidus? Diabetes Insipidus leads to frequent urination, and this is the most common and clear symptom. In extreme cases, urination can be in excess of 20 litres per day. A secondary symptom is increased thirst, as a result of passing so much water. If this is not met, then dehydration can occur which, in turn, can lead to: Cracked skin Confusion Dizziness and even Unconsciousness Children suffering from the condition may become irritable or listless, with fever and vomiting also possible. How does diabetes insipidus compare with diabetes mellitus? Diabetes insipidus and diabetes mellitus should not be confused. The two conditions are unrelated, with diabetes insipidus a completely different type of illness. Diabetes mellitus is also far more common. Diabetes mellitus occurs due to insulin resistance or insulin deficiency and subsequent high blood glucose levels. Diabetes Insipidus on the other hand develops as a result of the stilted production of a hormone in the brain, which is released to stop the kidneys producing so much urine in order to retain water. Without this hormone, water is not retained and the kidneys constantly work to their maximum capacity. The word "Mellitus" tagged onto the main form of diabetes comes from an old word roughly meaning "to Continue reading >>
