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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 >>

What Is Diabetes Insipidus?

What Is Diabetes Insipidus?

Most people have heard of the two main types of diabetes. But did you know the name has nothing to do with high blood sugar? It's a general term for any condition that causes your body to make a lot of urine. And that’s just what, diabetes insipidus does. This condition makes you extra thirsty. As a result, you pee -- a lot. Your body makes a substance called antidiuretic hormone (ADH). It’s produced in a part of your brain called the hypothalamus and stored in your pituitary gland. It tells your kidneys to hold onto water, which makes your urine more concentrated. When you’re thirsty or slightly dehydrated, ADH levels rise. Your kidneys reabsorb more water and put out concentrated urine. If you’ve had plenty to drink, ADH levels fall and what comes out is clear and dilute. When your body doesn’t make enough ADH, the condition is called central diabetes insipidus. If you make enough but your kidneys can't respond to it, you have nephrogenic diabetes insipidus. In either form, the result is the same. Your kidneys can't retain water, so even if you’re dehydrated, they'll put out a lot of pale, or diluted urine. When your kidneys can’t conserve water, you’ll: Get really thirsty Pee a lot -- this is known as polyuria Some people get dehydrated. If you lose too much water, you could have: Lethargy Muscle pains Irritability If you have this condition, you’ll probably wind up at the doctor for help with your thirst and constant need for a bathroom. To diagnose you, the 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 pee. He may give you an ADH substitute to see if your kidneys respond by concentrating your ur Continue reading >>

Diabetes Insipidus Workup

Diabetes Insipidus Workup

Approach Considerations In a patient whose clinical presentation suggests diabetes insipidus (DI), laboratory tests must be performed to confirm the diagnosis. A 24-hour urine collection for determination of urine volume is required. In addition, the clinician should measure the following: Perform testing with the patient maximally dehydrated as tolerated—that is, at a time when ADH release is the highest and his/her urine is the most concentrated. Water deprivation testing may be useful in situations in which the diagnosis is uncertain. A urinary specific gravity of 1.005 or less and a urinary osmolality of less than 200 mOsm/kg are the hallmark of DI. Random plasma osmolality generally is greater than 287 mOsm/kg. Suspect primary polydipsia when large volumes of very dilute urine occur with plasma osmolality in the low-normal range. Polyuria and elevated plasma osmolality despite a relatively high basal level of ADH suggests nephrogenic DI. Water deprivation followed by the administration of vasopressin may help to differentiate central from nephrogenic DI. The result of this test must be interpreted with caution, however, because patients with partial nephrogenic DI or primary polydipsia may show a response similar to that seen in central DI. Historically, diagnostic tests in DI can be traced back to the 1930s, when Gilman and Goodman first demonstrated recovery of an antidiuretic substance in the urine of rats following dehydration with hypertonic saline. When animals were provided free access to water, no antidiuretic activity was recovered from urine, and no antidiuretic activity could be recovered from the urine of hypophysectomized rats dehydrated with hypertonic saline. [25] Continue reading >>

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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 >>

Nephrogenic Diabetes Insipidus

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 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 >>

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

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 >>

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 Lab Values Explained

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

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 >>

Diabetes Insipidus In Children

Diabetes Insipidus In Children

What is diabetes insipidus? Diabetes insipidus is a condition that results from insufficient production of the antidiuretic hormone (ADH), or vasopressin, a hormone that helps the kidneys and body conserve the correct amount of water. Normally, ADH controls the kidneys' output of urine. It 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. ADH is secreted to decrease the amount of urine output so that dehydration does not occur. Diabetes insipidus, however, causes excessive production of very diluted urine and excessive thirst. The disease is categorized into groups: Central diabetes insipidus. An insufficient production or secretion of ADH; can be a result of damage to the hypothalamus or pituitary gland caused by head injuries, genetic disorders, and other diseases. Nephrogenic diabetes insipidus. A lack of kidney response to normal levels of ADH can be caused by drugs or chronic disorders, such as kidney failure, sickle cell disease, or polycystic kidney disease. It can also be genetic. What causes diabetes insipidus? Diabetes insipidus can be caused by several conditions, including the following: Malfunctioning hypothalamus (that produces too little ADH) Malfunctioning pituitary gland (that fails to release ADH into the bloodstream) Damage to hypothalamus or pituitary gland during surgery Brain injury Tumor Tuberculosis Blockage in the arteries leading to the brain Encephalitis (inflammation of the brain) Meningitis (inflammation of the meninges, the membranes that cover the brain and spinal cord) Sarcoidosis (a rare inflammation of the lymph nodes and other tissues throughout the body) Family heredity Certain drugs like lithium What are the symptoms of diabetes ins 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 >>

Nephrogenic Diabetes Insipidus

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 >>

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