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Why Is Urine Diluted In Diabetes Insipidus?

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 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: Causes, Symptoms And Treatment

Diabetes Insipidus: Causes, Symptoms And Treatment

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

Diabetes Insipidus

Diabetes Insipidus

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 >>

Diabetes Insipidus

Diabetes Insipidus

Diabetes insipidus is a condition in which your ability to control the balance of water within your body is not working properly. Your kidneys are not able to retain water and this causes you to pass large amounts of urine. Because of this, you become more thirsty and want to drink more. There are two different types of diabetes insipidus: cranial and nephrogenic. Cranial diabetes insipidus may only be a short-term problem in some cases. Treatment includes drinking plenty of fluids so that you do not become lacking in fluid in the body (dehydrated). Treatment with medicines may also be needed for both types of diabetes insipidus. A note about thirst and water balance in your body Getting the balance right between how much water your body takes in and how much water your body passes out is very important. This is because a large proportion (about 70%) of your body is actually water. Also, water levels in your body help to control the levels of some important salts, particularly sodium and potassium. Your body normally controls (regulates) water balance in two main ways: By making you feel thirsty and so encouraging you to drink and take more water in. Through the action of a chemical (hormone) called antidiuretic hormone (ADH) which controls the amount of water passed out in your urine. ADH is also known as vasopressin. It is made in a part of your brain called the hypothalamus. It is then transported to another part of your brain, the pituitary gland, from where it is released into your bloodstream. After its release, ADH has an effect on your kidneys. It causes your kidneys to pass out less water in your urine (your urine becomes more concentrated). So, if your body is lacking in fluid (dehydrated), your thirst sensation will be triggered, encouraging you to drink. As Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

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

Diabetes Insipidus

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 >>

Urine Output In Diabetes Insipidus

Urine Output In Diabetes Insipidus

INTRODUCTION Diabetes insipidus (DI) is a disorder in which polyuria due to decreased collecting tubule water reabsorption is induced by either decreased secretion of antidiuretic hormone (ADH) (central DI) or resistance to its renal effects (nephrogenic DI). In most patients, the degree of polyuria is primarily determined by the degree of ADH deficiency or resistance [1]. Thus, the urine output may range from 2 L/day with mild partial DI to over 10 to 15 L/day in patients with severe disease. Determinants of the urine output in patients with DI will be discussed here. The diagnosis of DI and the causes and treatment of central and nephrogenic DI are presented elsewhere. (See "Diagnosis of polyuria and diabetes insipidus" and "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".) DETERMINANTS OF URINE OUTPUT The determinants of the urine output differ in normal subjects and those with diabetes insipidus (DI). The urine output in normals primarily reflects water intake, which leads to alterations in the plasma osmolality that are sensed by the osmoreceptors in the hypothalamus that regulate both antidiuretic hormone (ADH) release and thirst [2,3]. In addition to central osmoreceptors, peripheral osmoreceptor neurons that innervate hepatic blood vessels detect osmotic shifts in portal blood and modulate ADH release [4]. (See "General principles of disorders of water balance (hyponatremia and hypernatremia) and sodium balance (hypovolemia and edema)", section on 'Regulation of plasma tonicity'.) Normally, an increase in water intake sequentially lowers the plasma osmolality, decreases ADH se 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 >>

Everything You Should Know About Diabetes Insipidus

Everything You Should Know About Diabetes Insipidus

What is diabetes insipidus? Diabetes insipidus (DI) is a rare condition that occurs when your kidneys are not able to conserve water. DI is not related to diabetes mellitus, which is often referred to simply as diabetes. That means you can have DI without having diabetes. In fact, the condition can occur in anyone. DI results in extreme thirst and frequent urination of dilute and odorless urine. There are several types of DI, and they can often be successfully treated. Keep reading to learn more about this condition. The main symptoms of DI are excessive thirst, which can cause an uncontrollable craving for water, and excessive urine volume. A healthy adult will typically urinate less than 3 quarts of urine a day. People with DI may eliminate up to 16 quarts of urine a day. You may need to get up during the night to urinate frequently, or you may experience bed-wetting. Possible symptoms in young children and infants include: fussiness and irritability unusually wet diapers or bed-wetting, or excessive urine output excessive thirst dehydration high fever dry skin delayed growth Adults can experience some of the above symptoms, plus confusion, dizziness, or sluggishness. DI can also lead to severe dehydration, which can lead to seizures, brain damage, and even death if not treated. You should contact your doctor immediately if you or your child is experiencing these symptoms. To understand diabetes insipidus, it helps to understand how your body normally uses and regulates fluids. Fluids make up as much as 60 percent of your overall body mass. Maintaining the proper amount of fluid in your body is key to your overall health. Consuming water and food throughout the day helps provide fluid to your body. Urinating, breathing, and sweating help to eliminate fluid from your b Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

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

What Is Diabetes Insipidus?

What Is Diabetes Insipidus?

Diabetes insipidus, not to be confused with the more common diabetes mellitus, is a relatively rare disorder resulting from a failure to produce sufficient amounts of vasopressin, also known as antidiuretic hormone (ADH). Vasopressin, produced by the hypothalamus and secreted by the posterior pituitary gland, helps the kidneys to reabsorb water and maintain proper fluid balance. If the pituitary fails to produce enough ADH, water is not conserved but simply passed through the kidneys and excreted, typically in very large quantities. More rarely, the kidneys fail to respond properly to ADH; this is known as nephrogenic diabetes insipidus. Dehydration is the primary health risk associated with either form. Diabetes insipidus affects both sexes equally. With proper treatment, overall prognosis is good (except in cases caused by cancer). What Causes Diabetes Insipidus? In approximately one third of all cases, the cause of diabetes insipidus is unknown. Hereditary factors may play a role in some cases. Damage to the pituitary gland from a head injury, a hypothalmic tumor, or inflammation, radiation therapy, or surgery may lead to diabetes insipidus. The most frequent cause of nephrogenic diabetes insipidus is therapy with lithium. Tuberculosis Blockage in an artery leading to the brain Symptoms of Diabetes Insipidus Frequent and excessive urination (output may be as high as 25 to 35 quarts within 24 hours and may be as frequent as every 30 minutes, even at night) Extreme thirst Dry skin Constipation Emergency symptoms of dehydration, including dizziness, weakness, and unconsciousness Prevention of Diabetes Insipidus There is no known way to prevent diabetes insipidus. Diagnosis of Diabetes Insipidus Physical examination and patient history are performed. Diagnosis of diabete Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

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

Diabetes Insipidus: Practice Essentials, Background, Etiology

Diabetes Insipidus: Practice Essentials, Background, Etiology

Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms: Central (neurogenic, pituitary, or neurohypophyseal) DI, characterized by decreased secretion of antidiuretic hormone (ADH; also referred to as arginine vasopressin [AVP]) Nephrogenic DI, characterized by decreased ability to concentrate urine because of resistance to ADH action in the kidney [ 1 ] Two other forms are gestational DI and primary polydipsia (dipsogenic DI); both are caused by deficiencies in AVP, but the deficiencies do not result from a defect in the neurohypophysis or kidneys. The predominant manifestations of DI are as follows: Polyuria: The daily urine volume is relatively constant for each patient but is highly variable between patients (3-20 L) The most common form is central DI after trauma or surgery to the region of the pituitary and hypothalamus, which may exhibit 1 of the following 3 patterns: Earley LE, Orloff J. The mechanism of antidiuresis associated with the administration of hydrochlorothiazide to patients with vasopressin-resistant diabetes insipidus. J Clin Invest. Nov 1962;41(11):1988-97. Babey M, Kopp P, Robertson GL. Familial forms of diabetes insipidus: clinical and molecular characteristics. Nat Rev Endocrinol. 2011 Jul 5. 7(12):701-14. [Medline] . Bockenhauer D, van't Hoff W, Dattani M, Lehnhardt A, Subtirelu M, Hildebrandt F, et al. Secondary nephrogenic diabetes insipidus as a complication of inherited renal diseases. Nephron Physiol. 2010. 116(4):p23-9. [Medline] . Los EL, Deen PM, Robben JH. Potential of nonpeptide (ant)agonists to rescue vasopressin V2 receptor mutants for the treatment of X-linked nephrogenic diabetes insipidus. J Neuroendocrinol. 2010 May. 22(5):393-9. [Medlin Continue reading >>

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