Drug Induced Diabetes Insipidus
Diabetes insipidus is often characterized by excessive thirst and excessive urination. This causes many people to experience dehydration over time, though dipsogenic diabetes insipidus may actually cause excessive hydration. In many instances, ADH suppression is caused by physical changes that have occurred in the central nervous system or the kidneys. It may be caused by a trauma, illness, or tumor in most circumstances. It may also be caused by certain medications that an individual may be taking for an unrelated condition. Drug induced diabetes insipidus will cause the same symptoms as any other form of DI. Over time, if the medication is taken continuously despite the physical symptoms, it is possible for drug induced diabetes insipidus to turn into nephrogenic or central diabetes insipidus. What Drugs Can Cause Diabetes Insipidus? Lithium is the most common medication that causes diabetes insipidus. This is because it affects the flow of sodium through the muscle and nerve cells in the body. It is often used to treat bipolar disorder, especially if an individual suffers from periodic episodes of mania. These additional medications are also known to cause diabetes insipidus as a side effect in some individuals. Amphotericin B: This medication is prescribed for individuals who are suffering from a serious fungal infection. It can also be used to treat leishmaniasis, which is caused by a parasite that is spread by certain biting sandflies. Known as Fungizone or Mysteclin-F, kidney problems are a common side effect with this injectable drug. Cidofovir: Also known as Vistide, this is an antiviral medication that is used to treat CMV retinitis when a patient has been diagnosed with AIDS. It can only be distributed through an intravenous formulation. Demeclocycline: This Continue reading >>
Diabetes Insipidus: A Challenging Diagnosis With New Drug Therapies
ISRN Nephrology Volume 2013 (2013), Article ID 797620, 7 pages Division of Nephrology, Department of Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA Academic Editors: M. Léone and D. Malhotra Copyright © 2013 Chadi Saifan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Diabetes Insipidus (DI) is either due to deficient secretion of arginine vasopressin (central) or to tubular unresponsiveness (nephrogenic). Drug induced DI is a well-known entity with an extensive list of medications. Polyuria is generally defined as urine output exceeding 3 liters per day in adults. It is crucial to identify the cause of diabetes insipidus and to implement therapy as early as possible to prevent the electrolyte disturbances and the associated mortality and morbidity. It is very rare to have an idiosyncratic effect after a short use of a medication, and physicians should be aware of such a complication to avoid volume depletion. The diagnosis of diabetes insipidus is very challenging because it relies on laboratory values, urine output, and the physical examination of the patient. A high clinical suspicion of diabetes insipidus should be enough to initiate treatment. The complications related to DI are mostly related to the electrolyte imbalance that can affect the normal physiology of different organ systems. 1. Background Though it is a rare disorder, diabetes insipidus was first described in the 18th century [1]. Diabetes insipidus (DI) is either due to deficient secretion of arginine vasopressin (AVP), also known as antidiuretic hormone (ADH) by the pitu Continue reading >>
Medications For Diabetes Insipidus
This medication may not be approved by the FDA for the treatment of this condition. Prescription Only / Over the Counter Rx Prescription Only OTC Over the Counter Rx/OTC Prescription or Over the Counter Pregnancy A Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use in pregnant women despite potential risks. D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use in pregnant women despite potential risks. X Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use in pregnant women clearly outweigh potential benefits. N FDA has not classified the drug. Controlled Substances Act Schedule N Is not subject to the Controlled Substances Act. 1 Has a high potential for abuse. Has no currently accepted medical use in treatment in the United States. There is a lack of accepted safety for use under medical supervision. 2 Has a high potential for abuse. Has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. Abuse may lead to severe psychological or physical dependence Continue reading >>
Diabetes Insipidus Medication: Vasopressin-related Hormones, Antidiabetics, Sulfonylureas, Anticonvulsants, Diuretics, Thiazide, Nonsteroidal Anti-inflammatory Agents (nsaids), Diuretics, Potassium-sparing
Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... Treatment for diabetes insipidus (DI) varies with the form of the disorder. In central DI and most cases of gestational DI, the primary problem is a deficiency of antidiuretic hormone (ADH)also known as arginine vasopressin (AVP)and therefore, physiologic replacement with desmopressin is usually effective. A nonhormonal drug can be used if response is incomplete or desmopressin is too expensive. Desmopressin has no role in the treatment of nephrogenic DI or primary polydipsia. Nonhormonal drugs usually are more effective in treating nephrogenic DI. In patients with central DI, replacement of endogenous ADH with exogenous hormones prevents complications of DI and reduces morbidity. Vasopressin has vasopressor and ADH activity. It increases water resorption at collecting ducts (ADH effect). At high doses, it also promotes smooth muscle contraction throughout the vascular bed of renal tubular epithelium (vasopressor effects). However, vasoconstriction is also increased in splanchnic, portal, coronary, cerebral, peripheral, pulmonary, and intrahepatic vessels. Chlorpropamide promotes renal response to ADH. Carbamazepine possibly ameliorates DI by promoting the release of ADH. It is not useful in nephrogenic DI and generally is not a first-line drug. Hydrochlorothiazide is a thiazide diuretic that decreases urinary volume in the absence of ADH. It may induce mild volume depletion and cause proximal salt and water retention, thereby reducing flow to the ADH-sensitive distal nephron. Its effects are additive to those of other agents. Nonsteroidal Anti-inflammatory Agents (NSAIDs) The mechanism of action of NSAIDs is not known, but these agents may act by inhibiting prostaglandin synthesis. Inh Continue reading >>
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 >>
Common Drugs
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Treatment
Treatments for diabetes insipidus aim to reduce the amount of urine your body produces. Depending on the type of diabetes insipidus you have, there are several ways of treating your condition and controlling your symptoms. Cranial diabetes insipidus Mild cranial diabetes insipidus may not require any medical treatment. Cranial diabetes insipidus is considered mild if you produce approximately 3-4 litres of urine over 24 hours. If this is the case, you may be able to ease your symptoms by increasing the amount of water you drink, to avoid dehydration. Your GP or endocrinologist (specialist in hormone conditions) may advise you to drink a certain amount of water every day, usually at least 2.5 litres. However, if you have more severe cranial diabetes insipidus, drinking water may not be enough to control your symptoms. As your condition is due to a shortage of vasopressin (AVP), your GP or endocrinologist may prescribe a treatment that takes the place of AVP, known as desmopressin (see below). Desmopressin Desmopressin is a manufactured version of AVP that's more powerful and more resistant to being broken down than the AVP naturally produced by your body. It works just like natural AVP, stopping your kidneys producing urine when the level of water in your body is low. Desmopressin can be taken as a nasal spray, in tablet form or as a form that melts in your mouth, between your gum and your lip. If you're prescribed desmopressin as a nasal spray, you'll need to spray it inside your nose once or twice a day, where it's quickly absorbed into your bloodstream. If you're prescribed desmopressin tablets, you may need to take them more than twice a day. This is because desmopressin is absorbed into your blood less effectively through your stomach than through your nasal passage Continue reading >>
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Drug-induced Diabetes Insipidus: Incidence, Prevention And Management.
Abstract Drug-induced diabetes insipidus is always of the nephrogenic type, i.e. unresponsiveness of the kidneys to the action of antidiuretic hormone. This condition is easily diagnosed by measuring urinary concentrating capacity during a thirst test (e.g. 12 hours of water deprivation) or by administration of a modified antidiuretic hormone, desmopressin, to demonstrate the renal unresponsiveness. Drug-induced nephrogenic diabetes insipidus is not a common disorder except in patients receiving treatment with lithium salts for affective disorders where it may affect about 10% of patients treated long term (15 years). Drug-induced nephrogenic diabetes insipidus caused by other drugs usually occurs in critically ill patients in intensive care units receiving a multitude of drugs dominated by antimicrobials and cytostatics. A search of the World Health Organization's adverse effect database revealed 359 reports of drug-induced diabetes insipidus. Lithium was the most common cause (159 reports) followed by foscarnet (15) and clozapine (10). Treatment is symptomatic in most patients and the offending drug should be stopped. If urine volumes exceed 4 L/day, treatment with thiazides and amiloride has been advocated, and nonsteroidal anti-inflammatory drugs, such as indomethacin, may be tried in severe cases. Prevention of lithium-induced nephrogenic diabetes insipidus is an important aspect of the treatment of affective disorders. In patients treated long term it appears to be only partly reversible upon lithium discontinuation. Close monitoring of the treatment aiming at 12-hour trough value of 0.4 to 0.6 mmol/L is recommended. Yearly measurement of the urinary volume/day is effective in making both the patient and the physician aware of the development of the drug-induced n Continue reading >>
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Dealing With Diabetes Insipidus In Animals
Diabetes Insipidus: Symptoms Checklist Could your dog or cat have Diabetes Insipidus (DI)? If your pet is drinking and urinating excessively, then Diabetes Insipidus might be the cause. This guide will help you learn more about this disease and what warning signs to watch out for. What Is Diabetes Insipidus? Diabetes Insipidus is one of two types of diabetes that can affect dogs and cats, the other being Diabetes Mellitus. Diabetes Insipidus, also known as “watery diabetes” or “weak diabetes,” is the more rare of the two types, and it can only be diagnosed after performing extensive urine and blood tests. This type of diabetes is known as watery diabetes because it affects a pet’s water metabolism. It causes the pet to release too much water instead of storing it. Because the pet can’t retain the water, the pet will usually exhibit significantly increased thirst and urination. Two Forms of Diabetes Insipidus Diabetes Insipidus is seen in dogs and cats in two different forms, neurogenic DI and nephrogenic DI. Neurogenic DI is caused by a lack of the hormone vasopressin, which his crucial for managing the body’s ability to retain water. Nephrogenic DI is caused when there’s a deficiency of antidiuretic hormone (ADH) in the body. ADH is the hormone that stimulates the capillary muscles and reduces the flow of urine. Preventing Diabetes Insipidus There isn’t much a pet owner can do to help prevent their pet from developing Diabetes Insipidus because in most cases, the disease is due to either an inadequate secretion of ADH or a renal insensitivity to the hormone. Signs and Symptoms of Diabetes Insipidus If you think your dog or cat might have this form of diabetes, you may start to notice several tell-tale signs. Here is a checklist that you can use to mon Continue reading >>
Diabetes Insipidus
What is diabetes insipidus? Diabetes insipidus is a condition that results from insufficient production of the antidiuretic hormone (ADH), a hormone that helps the kidneys and body conserve the correct amount of water. Normally, the antidiuretic hormone controls the kidneys' output of urine. It is secreted by the hypothalamus (a small gland located at the base of the brain) and 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. Two of the groups are described below: central diabetes insipidus — insufficient production or secretion of ADH; can be a result of damage to the pituitary gland caused by head injuries, genetic disorders, tumors, surgery, and other diseases. nephrogenic diabetes insipidus — 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. Causes of diabetes insipidus: Diabetes insipidus can be caused by several conditions, including the following: malfunctioning hypothalamus damage to hypothalamus or pituitary gland during surgery brain injury tumor tuberculosis blockage in the arteries leading to the brain encephalitis meningitis sarcoidosis (a rare inflammation of the lymph nodes and other tissues throughout the body) What are the symptoms of diabetes insipidus? The following are the most common symptoms of diabetes insipidus. However, each individual may experience symptoms differently. Symptoms may include: excessive thirst excessive urine production dehydration The symptoms of diabetes ins Continue reading >>
Diabetes Insipidus Treatment
Diabetes insipidus treatment depends on the type and therefore pathology of the condition. For example, treatment of cranial or central diabetes insipidus aims at correcting deficient levels of the fluid regulator antidiuretic hormone (ADH) or vasopressin. Among those who have the nephrogenic form of disease however, ADH levels are normal and treatment is aimed at reducing diuresis or loss of excess water from the body. Treatment The general outline for treating diabetes insipidus is given below: Treatment of cranial diabetes insipidus Mild cases of cranial diabetes insipidus do not usually require any medical treatment and patients are usually advised to drink more water to compensate for the water loss. Diabetes insipidus is considered mild if around 3 to 4 litres of urine is passed every 24 hours. In more severe cases, the deficient ADH or vasopressin may be replaced by a synthetic substitute called desmopressin. Desmopressin is used most widely in the form of a nasal spray that is used once or twice a day. Also available is a tablet form of the drug but this may need to be taken more than twice a day since absorption of the tablet form is less effective than with the nasal spray. The side effects of desmopressin are usually mild and include a blocked or runny nose, stomach ache, headache, and nosebleed. However, a combination of excessive water intake along with the use of desmopressin can cause low sodium levels in the blood, a condition called hyponatremia. Thiazide diuretics are a form of medication that is commonly used to treat water retention and increase the passage of water in urine. However, in patients with diabetes insipidus, the drug raises the concentration of urine and reduces the amount of urine passed from the body. Non-steroidal anti-inflammatory dr Continue reading >>
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 >>
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 Treatment
For most patients with diabetes insipidus, treatment often involves a few lifestyle changes and the regular consumption of fluids to prevent dehydration. Each patient will be given a customized treatment plan when this disease is diagnosed and it will be based on the type of diabetes insipidus that is present. From there, frequent monitoring of the condition is often necessary to maintain an active lifestyle. All patients should continue to exercise, enjoy sporting activities, and live life to its fullest. Just have fluids available at all times to replenish that extra water that will be removed because of the body’s lack of response to the hormone Vasopressin. In general, however, these are the general treatment profiles for each type of diabetes insipidus. If you are seeking a diabetes insipidus treatment, you may qualify for a medical exemption certificate depending on your location and health care plan. Check with your health insurance company or medical provider for what may be available for you. How To Treat Central Diabetes Insipidus In this version of diabetes insipidus, there is a lack of Vasopressin in the body because of an injury to the pituitary gland. Sometimes a problem with the hypothalamus may also cause a lack of Vasopressin within the blood stream. To counter this problem, endocrinologists will typically order injections of a synthetic hormone called Desmopressin to support the body’s natural functioning for immediate support. Injections to treat central diabetes insipidus do not occur forever. They are simply used to “kickstart” the body. Desmopressin is typically taken as an oral tablet or through a nasal spray. When enough of the hormone is present, the need to urinate more frequently than normal disappears. It is considered a PRN medicatio Continue reading >>
Diabetes Insipidus
What are the types of diabetes insipidus? Central Diabetes Insipidus The most common form of serious diabetes insipidus, central diabetes insipidus, results from damage to the pituitary gland, which disrupts the normal storage and release of ADH. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking desmopressin, a person should drink fluids only when thirsty and not at other times. The drug prevents water excretion, and water can build up now that the kidneys are making less urine and are less responsive to changes in body fluids. Nephrogenic Diabetes Insipidus Nephrogenic diabetes insipidus results when the kidneys are unable to respond to ADH. The kidneys' ability to respond to ADH can be impaired by drugs-like lithium, for example-and by chronic disorders including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of nephrogenic diabetes insipidus is never discovered. Desmopressin will not work for this form of diabetes insipidus. Instead, a person with nephrogenic diabetes insipidus may be given hydrochlorothiazide (HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again, with this combination of drugs, one should drink fluids only when thirsty and not at other times. Dipsogenic Diabetes insipidus Dipsogenic diabetes insipidus is caused by a defect in or damage to the thirst Continue reading >>
