diabetestalk.net

How Do You Test For Diabetes Insipidus?

Diabetes Insipidus

Diabetes Insipidus

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Diabetes Insipidus article more useful, or one of our other health articles. Diabetes insipidus (DI) is a condition caused by hyposecretion of, or insensitivity to the effects of, antidiuretic hormone (ADH), also known as arginine vasopressin (AVP). ADH is synthesised in the hypothalamus and transported as neurosecretory vesicles to the posterior pituitary. There it is released into the circulation, governed by plasma osmolality. Its deficiency or failure to act causes an inability to concentrate urine in the distal renal tubules, leading to the passage of copious volumes of dilute urine. Usually the person with this condition passes >3 litres/24 hours of low osmolality (<300 mOsmol/kg) urine. There are two major forms of DI: Cranial DI: decreased secretion of ADH. Decreased secretion of ADH reduces the ability to concentrate urine and so causes polyuria and polydipsia. Nephrogenic DI: decreased ability to concentrate urine because of resistance to ADH in the kidney. There are two other forms of DI (both caused by deficiencies in ADH; however, the deficiencies do not result from a defect in the neurohypophysis or kidneys): Gestational DI: results from degradation of vasopressin by a placental vasopressinase. Gestational DI may be associated with increased complications of pregnancy, including pre-eclampsia.[1] Primary polydipsia (dipsogenic DI): caused by a primary defect in osmoregulation of thirst. Dipsogenic DI has been reported in tuberculous meningitis, multiple sclerosis and neurosarcoidosis. The combined prevalence of cranial DI and nephrogenic D Continue reading >>

Diabetes Insipidus In Dogs

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 >>

Diabetes Insipidus In Children

Diabetes Insipidus In Children

What is diabetes insipidus? Diabetes insipidus is an uncommon condition that causes excessive production of very diluted urine and intense thirst. In a healthy body, the kidneys filter waste from the blood in a constant flow. Water cleaned of waste is reabsorbed back into the bloodstream and the body. Waste is concentrated in the kidneys into a small amount of urine and excreted. Antidiuretic hormone (ADH or vasopressin) helps the kidneys and body conserve the correct amount of water. ADH is secreted by the hypothalamus (a small gland located at the base of the brain), stored in the pituitary gland, and then released into the bloodstream. The underlying problem in diabetes insipidus is either too little ADH reaching the kidneys or the failure of the kidneys to respond to it. For either reason, when a person has diabetes insipidus the kidneys are unable to concentrate the urine, and large amounts of dilute urine are released. The disease is separated into two categories: Central diabetes insipidus results from an insufficient production or secretion of ADH. Nephrogenic diabetes insipidus results from a lack of kidney response to normal levels of ADH. Note that diabetes insipidus is not related to diabetes mellitus, a more common and better-known disorder in the production of a different hormone, insulin. Causes of diabetes insipidus Central diabetes insipidus can be the result of damage to the hypothalamus or pituitary gland caused by: Brain surgery Brain malformation Tumor in or near the pituitary gland Inflammation of the pituitary gland (hypophysitis) Langerhan cell histiocytosis Some genetic disorders Head injury Interruption of the blood supply to the pituitary gland Encephalitis (inflammation of the brain) Meningitis (inflammation of the meninges, the membranes tha Continue reading >>

Central Diabetes Insipidus

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 >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

You’ve become the New York Times and the Wall Street Journal of medicine. A must-read every morning. ” Continue reading >>

How Is Di Diagnosed?

How Is Di Diagnosed?

Before getting to a diagnosis of DI, your vet will need to rule out other diseases that could make your pet pee a lot and drink a lot. Your vet may refer to this as PU/PD for polyuria (pee a lot) and polydipsia (drink a lot.) The most common diseases causing PU/PD include kidney infection or kidney disease, hyperthyroidism (cats), and diabetes mellitus. Other diseases the vet may want to rule out include hyperadrenocorticism (usually dogs, rarely cats), liver disease, hypercalcemia (high blood levels of calcium), acromegaly (cats) and pyometra (infection of the uterus in unspayed female pets only.) Generally, a physical exam coupled with blood and urine tests can help rule these problems out. The next step is to test the urine and see how concentrated it is. If it has a low specific gravity, your vet may suspect DI. There is a test that is used to diagnose DI and differentiate between CDI and NDI. This is the water deprivation test (or modified water deprivation test.) Many vets suggest doing this test when they suspect DI. However, you should know that there are dangers and problems associated with this test. There is a safer way to determine if your pet has CDI. What are the problems with the water deprivation test? First, since water is withheld, if you pet has DI, they will begin to dehydrate. As part of the test, your vet will weigh your pet. The test does not stop until your pet loses 5% of its body weight (or gets sick from retention of toxins in the blood.) This can be very dangerous. If your vet does this test, be sure to check what type of scales they use to weigh the pet. Baby scales and holding the pet while standing on a human bath scale are probably not accurate enough to make the test safe. If a cat weighs only 6 pounds, 5% of the body weight will be less Continue reading >>

Diabetes Insipidus (water Diabetes) In Cats And Dogs

Diabetes Insipidus (water Diabetes) In Cats And Dogs

Overview of diabetes insipidus Most everyone is familiar with the term “diabetes;” it is a common human disease. But our four-legged friends can get diabetes, too. There are different types of diabetes, one being diabetes insipidus—an uncommon disorder that affects our pet’s ability to conserve water. Because of this disease, your dog or cat urinates and drinks water excessively in an attempt to keep up with the loss of water through the urine. There are two types of diabetes insipidus. One is due to the insufficient production of a hormone called antidiuretic hormone (ADH) that regulates the body’s ability to absorb water from the kidneys. The other form of diabetes insipidus is caused by the kidneys’ inability to respond to ADH. The kidneys are responsible for regulating the water in your pet’s body. So, without this hormone or the kidney’s response to it, your dog or cat can’t conserve water. Access to water is critical for pets with diabetes insipidus—without it, a dog or cat can become dehydrated in as little as 4–6 hours. Generally, diabetes insipidus is considered idiopathic, which means the ultimate cause is unknown. Possible causes include congenital issues, trauma, metabolic conditions, kidney disease, adverse reactions to certain medications, or tumors of the pituitary gland. Despite the underlying cause of diabetes insipidus, the symptoms are the same. They include: Diagnosis of diabetes insipidus Your veterinarian will perform a thorough physical exam and take a detailed history of your pet’s health. The symptoms of diabetes insipidus are very similar to other diseases, such as diabetes mellitus (“sugar diabetes”), Cushing’s syndrome, liver or kidney disease, Addison’s disease, and hypo-/hyperthyroidism. Your veterinarian may Continue reading >>

Water Diabetes In Dogs

Water Diabetes In Dogs

Diabetes Insipidus in Dogs Diabetes insipidus (DI) is a rare disorder that affects water metabolism, preventing the body from conserving water and releasing too much of it. This condition is characterized by increased urination, dilute urine (so-called insipid, or dull urine), and increased thirst and drinking. This disease is not related to diabetes mellitus (insulin diabetes). Symptoms and Types There are two main types of DI that affect dogs: neurogenic (or central diabetes insipidus) and nephrogenic diabetes insipidus. In neurogenic DI, the cause is due to a lack of the hormone vasopressin, which regulates the body's retention of water. The release of vasopressin is produced and regulated by the hypothalamus (in the brain), so a dysfunction in its release may be due to a head injury, or to a tumor in the brain. Vasopressin is produced in the hypothalamus into the connected pituitary gland, and is then released into the bloodstream. A lack of vasopressin may be due to a failure in the hypothalamus, or a failure in the pituitary gland. A significant number of cases is idiopathic. Nephrogenic DI, meanwhile, can be caused by a deficiency of antidiuretic hormone (ADH), which functions to stimulate the capillary muscles and reduce the flow of urine, effectively conserving water for the body's various functions. The cause is found in the kidneys and their inability to respond appropriately to ADH, allowing too much water from the body to escape into the urine. This is typically an acquired condition, and may be due to amyloidosis of the kidney, cysts on the kidney, or an imbalance of electrolytes. Other common symptoms seen in dogs with DI include: Causes Inadequate secretion of antidiuretic hormone ADH Congenital defect Unknown causes Trauma Cancer Renal insensitivity to Continue reading >>

Diagnosing Diabetes Insipidus In Dogs

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

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 In Children

Diabetes Insipidus In Children

What is diabetes insipidus in children? Diabetes insipidus is a condition caused by not enough antidiuretic hormone (ADH) in the body. ADH is also known as vasopressin. This is a hormone that helps the kidneys keep the correct amount of water in the body. The condition is also called “water diabetes.” ADH controls how much water is in urine that the kidneys make. ADH is secreted by a small gland at the base of the brain called the hypothalamus. It’s stored in the pituitary gland, and then released into the bloodstream when needed. ADH lowers the amount of water the kidneys make into urine. This helps prevent dehydration. With diabetes insipidus, too much water is pulled from the blood by the kidneys. This causes the body to create a lot of watery urine, and leads to thirst. The disease has 2 types: Central diabetes insipidus. With this type, not enough ADH is made or secreted. This is most often because of damage to the hypothalamus or pituitary gland. Typical causes include injury to the brain and rare genetic disorders. Nephrogenic diabetes insipidus. With this type, the kidneys don’t respond normally to ADH. This is most often because of medicines or chronic disorders. Some genetic disorders can affect the kidneys from birth. Other causes of kidney problems include kidney failure, sickle cell disease, and polycystic kidney disease. What causes diabetes insipidus in a child? Diabetes insipidus can be caused by conditions such as: A hypothalamus gland that doesn’t make enough ADH A pituitary gland that doesn’t release enough ADH into the blood Damage to the hypothalamus or pituitary gland during surgery or radiation therapy Brain injury Brain tumor Tuberculosis Blockage in the arteries leading to the brain Inflammation of the brain (encephalitis) Inflammati Continue reading >>

Diagnosis

Diagnosis

See your GP if you have the symptoms of diabetes insipidus. They'll ask about your symptoms and carry out a number of tests. You may be referred to an endocrinologist (a specialist in hormone conditions) for these tests. As the symptoms of diabetes insipidus are similar to those of other conditions, including type 1 diabetes and type 2 diabetes, tests will be needed to confirm which condition you have. If diabetes insipidus is diagnosed, the tests will also be able to identify the type you have – cranial or nephrogenic. Water deprivation test A water deprivation test involves not drinking any liquid for several hours to see how your body responds. If you have diabetes insipidus, you'll continue to pass large amounts of dilute urine, when normally you'd only pass a small amount of concentrated urine. During the test, the amount of urine you produce will be measured. You may also need a blood test to assess the levels of antidiuretic hormone (ADH) in your blood. Your blood and urine may also be tested for substances such as glucose (blood sugar), calcium and potassium. If you have diabetes insipidus, your urine will be very dilute, with low levels of other substances. A large amount of sugar in your urine may be a sign of type 1 or type 2 diabetes rather than diabetes insipidus. Vasopressin test After the water deprivation test, you may be given a small dose of AVP, usually as an injection. This will show how your body reacts to the hormone, which helps to identify the type of diabetes insipidus you have. If the dose of AVP stops you producing urine, it's likely your condition is due to a shortage of AVP. If this is the case, you may be diagnosed with cranial diabetes insipidus. If you continue to produce urine despite the dose of AVP, this suggests there's already enou Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

show all detail Diagnostic Tests 1st Tests To Order Test Result urine osmolality To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In low: typically <300 mOsm/kg H2O serum osmolality To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In normal or elevated serum sodium To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In normal or elevated serum calcium To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In normal or elevated serum potassium To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In normal or low urine dipstick To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In negative for glycosuria 24-hour urine collection for volume To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In >3 liters per 24 hours serum BUN To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! Current Members - Sign In normal or elevated serum glucose To access clinical pearls and in-depth diagnosis and treatment information, sign up for a FREE Epocrates Online account. Sign Up Now! C Continue reading >>

A Water Deprivation Test For The Diagnosis Of Diabetes Insipidus In Children

A Water Deprivation Test For The Diagnosis Of Diabetes Insipidus In Children

THE SEPARATION of patients with diabetes insipidus from individuals with normal ability to form concentrated urine has not always been satisfactory. Three diagnostic procedures have been utilized to make this differentiation. The Carter-Robbins test1 based on the observations of Hickey and Hare2 has been the procedure most frequently employed. The test is preceded by an overnight period of dehydration which in itself is dangerous in the small child with diabetes insipidus. The intravenous infusion is uncomfortable and catheterization of the bladder is frequently necessary to collect accurately timed urine samples. A second diagnostic procedure has been the parenteral administration of nicotine to stimulate antidiuretic hormone release.3 This has proven to be unreliable and uncomfortable for the patient. A water deprivation test employing the measurement of urinary specific gravity4 has been largely abandoned because the 24-hour period of dehydration required was hazardous in patients with diabetes insipidus. Continue reading >>

Diabetes Insipidus

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 >>

More in diabetes