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(/* Common causes {{cite journal| author=Wieliczko M, Matuszkiewicz-Rowińska J| title=[Polyuria]. | journal=Wiad Lek | year= 2013 | volume= 66 | issue= 4 | pages= 324-8 | pmid=24490488 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24490488 }} {{cite journal| author=Weiss JP, Everaert K| title=Management of Nocturia and Nocturnal Polyuria. | journal=Urology | year= 2019 | volume= 133S | issue= | pag...)
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! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align=center| {{fontcolor|#2B3B44|Polyuria Resident Survival Guide Microchapters}}
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Polyuria resident survival guide#Overview|Overview]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Polyuria resident survival guide#Causes|Causes]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Polyuria resident survival guide#Approach to Polyuria|Diagnosis]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Polyuria resident survival guide#Treatment|Treatment]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Polyuria resident survival guide#Do's|Do's]]
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{{CMG}}; {{AE}} {{ZO}}
{{SK}} Approach to polyuria, Approach to dilute urine, Polyuria management, Polyuria work-up
==Overview==
==Overview==
* [[Polyuria]] is defined as [[urine]] [[output]] more than 2 L/24 hours, or 30 ml/kg/24 hours. There are 3 [[pathophysiologic]] causes of [[polyuria]]: increased [[thirst]] ([[idiopathic]], [[psychogenic]] [[polydepsia]], [[hypothalamic]] disease, and [[medications]]), [[central diabetes insipidus]] (DI) (decreased secretion of [[arginine vasopressin]] ([[AVP]])), and [[nephrogenic diabetes insipidus]] (DI) ([[renal]] resistance to [[AVP]]).<ref name="pmid12617410">{{cite journal| author=Moore K, Thompson C, Trainer P| title=Disorders of water balance. | journal=Clin Med (Lond) | year= 2003 | volume= 3 | issue= 1 | pages= 28-33 | pmid=12617410 | doi=10.7861/clinmedicine.3-1-28 | pmc=4953350 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12617410  }} </ref>
* [[Polyuria]] is defined as [[urine]] [[output]] more than 2 L/24 hours, or 30 ml/kg/24 hours. There are 3 [[pathophysiologic]] causes of [[polyuria]]: increased [[thirst]] ([[idiopathic]], [[psychogenic]] [[polydepsia]], [[hypothalamic]] disease, and [[medications]]), [[central diabetes insipidus]] (DI) (decreased secretion of [[arginine vasopressin]] ([[AVP]])), and [[nephrogenic diabetes insipidus]] (DI) ([[renal]] resistance to [[AVP]]).<ref name="pmid12617410">{{cite journal| author=Moore K, Thompson C, Trainer P| title=Disorders of water balance. | journal=Clin Med (Lond) | year= 2003 | volume= 3 | issue= 1 | pages= 28-33 | pmid=12617410 | doi=10.7861/clinmedicine.3-1-28 | pmc=4953350 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12617410  }} </ref>
* [[Nocturnal]] [[polyuria]] ([[NP]]), characterized by [[overproduction]] of [[urine]] at night (more than 20%-33% of total 24-hour urine volume depending on age). It can be caused by intake, [[urological]], [[nephrological]], [[hormonal]], [[sleep]], and [[cardiovascular]] factors. <ref name="pmid31586470">{{cite journal| author=Weiss JP, Everaert K| title=Management of Nocturia and Nocturnal Polyuria. | journal=Urology | year= 2019 | volume= 133S | issue=  | pages= 24-33 | pmid=31586470 | doi=10.1016/j.urology.2019.09.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31586470  }} </ref>
==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
 
*Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
*Polyuria does not have life-threatening causes.
===Common causes <ref name="pmid24490488">{{cite journal| author=Wieliczko M, Matuszkiewicz-Rowińska J| title=[Polyuria]. | journal=Wiad Lek | year= 2013 | volume= 66 | issue= 4 | pages= 324-8 | pmid=24490488 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24490488  }} </ref>  <ref name="pmid31586470">{{cite journal| author=Weiss JP, Everaert K| title=Management of Nocturia and Nocturnal Polyuria. | journal=Urology | year= 2019 | volume= 133S | issue=  | pages= 24-33 | pmid=31586470 | doi=10.1016/j.urology.2019.09.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31586470  }} </ref>===
===Common causes <ref name="pmid24490488">{{cite journal| author=Wieliczko M, Matuszkiewicz-Rowińska J| title=[Polyuria]. | journal=Wiad Lek | year= 2013 | volume= 66 | issue= 4 | pages= 324-8 | pmid=24490488 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24490488  }} </ref>  <ref name="pmid31586470">{{cite journal| author=Weiss JP, Everaert K| title=Management of Nocturia and Nocturnal Polyuria. | journal=Urology | year= 2019 | volume= 133S | issue=  | pages= 24-33 | pmid=31586470 | doi=10.1016/j.urology.2019.09.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31586470  }} </ref>===
* The most common causes of '''[[polyuria]]''' are:  
* The most common causes of '''[[polyuria]]''' are:  
**[[Pregnancy]]
**[[Pregnancy]]
**[[Psychogenic]] [[polydipsia]]
**[[Psychogenic polydipsia]]
**Central [[diabetes insipidus]] ([[CDI]])
**[[Central diabetes insipidus]] ([[CDI]])
**Nephrogenic [[diabetes insipidus]] ([[NDI]])
**[[Nephrogenic diabetes insipidus]] ([[NDI]])
**[[Diabetes mellitus]] ([[DM]])
**[[Diabetes mellitus]] ([[DM]])
**[[Chronic kidney disease]] ([[CKD]])
**[[Chronic kidney disease]] ([[CKD]])
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**[[Interstitial cystitis]]
**[[Interstitial cystitis]]
**[[Nephrolithiasis]]
**[[Nephrolithiasis]]
**[[Hypercalcemia]]
**[[Primary hyperparathyroidism]]
**[[Sickle cell anemia]] ([[SCA]])
**[[Familial hypocalciuric hypercalcemia]]
**[[Hypercalcemia]]
**[[Hypokalemia]]
**[[Sickle cell disease]] ([[SCD]])
**[[Stroke]] or [[neurological]] diseases
**[[Benign prostatic hyperplasia]] ([[BPH]])
**[[Benign prostatic hyperplasia]] ([[BPH]])
**[[Stress incontinence]]
**[[Stress incontinence]]
**[[Diuretic]] use
**[[Medications]]:
***[[Lithium]]
***[[diuretics]]
**[[Overactive bladder]]
**[[Overactive bladder]]
**[[Stroke]] or [[neurological]] diseases
**Drinking alcohol or caffeine


* '''[[Nocturnal]] [[Polyuria]]''' ([[NP]]) can be caused by different medical conditions including:
==Approach to Polyuria==
**[[Congestive heart failure]] ([[CHF]])
**[[Diabetes mellitus]] ([[DM]])
**[[Obstructive sleep apnea]] ([[OSA]])
**[[Peripheral edema]]
**Excessive nighttime fluid intake
**Abnormalities in [[antidiuretic hormone]] [[arginine vasopressin]] ([[AVP]]) [[secretion]] can cause [[overproduction]] of [[urine]] at night
**[[Nocturnal]] [[Polyuria]] [[Syndrome]], in the absence of any medical condition, it can be due to impaired [[circadian]] release of [[Arginine vasopressin]]([[AVP]]).


==Diagnosis==
Shown below is an algorithm summarizing the approach to [[polyuria]].<br>
 
<span style="font-size:85%">'''Abbreviations:'''
* [[Water]] [[deprivation]] [[test]] combined with [[desmopressin]] administration is the diagnostic '''gold standard''', it [[differentiate]]s between the causes of the [[polyuria]]‐[[polydipsia]] [[syndrome]].
'''DI:''' Diabetes insipidus;
 
* The [[c‐terminal]] [[portion]] of the larger [[precursor]] [[peptide]] of [[Arginine Vasopressin]] [[AVP]] ([[co-peptin]]), has been evaluated in the setting of [[polyuria]]‐[[polydipsia]] [[syndrome]], can be useful for the differential diagnosis. <ref name="pmid28967192">{{cite journal| author=Nigro N, Grossmann M, Chiang C, Inder WJ| title=Polyuria-polydipsia syndrome: a diagnostic challenge. | journal=Intern Med J | year= 2018 | volume= 48 | issue= 3 | pages= 244-253 | pmid=28967192 | doi=10.1111/imj.13627 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28967192  }} </ref>
 
==Approach to Polyuria==


</span>
===Hypotonic Polyuria===
{{Family tree/start}}  
{{Family tree/start}}  
{{Family tree | | | | | | | | | | | | | A01 | | | | |A01='''Suspected hypotonic polyuria'''<ref name="pmid30779536">{{cite journal| author=Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dungan K | display-authors=etal| title=Endotext | journal= | year= 2000 | volume=  | issue=  | pages=  | pmid=30779536 | doi= | pmc= | url= }} </ref>}}
{{Family tree | | | | | | | | | | | | | A01 | | | | |A01='''Suspected hypotonic polyuria'''<ref name="pmid30779536">{{cite journal| author=Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dungan K | display-authors=etal| title=Endotext | journal= | year= 2000 | volume=  | issue=  | pages=  | pmid=30779536 | doi= | pmc= | url= }} </ref>}}
{{Family tree | | | | | | | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | | | | | | | B01 | | | | |B01='''Confirm presence of polyuria''':<br>'''(>50ml/kg/24hrs or >3-4L/day)'''}}
{{Family tree | | | | | | | | | | | | | B01 | | | | |B01='''Confirm presence of polyuria'''<br>'''>50ml/kg/24hrs or >3-4L/day'''}}
{{Family tree | | | | | | | | | | |,|-|-|^|-|-|.| | }}
{{Family tree | | | | | | | | | | |,|-|-|^|-|-|.| | }}
{{Family tree | | | | | | | | | | C01 | | | | C02 |C01=(Polyuria confirmed):<br>'''Measure urine osmolality'''|C02=(No polyuria/ or >800 mOsm/kg):<br>'''Diabetes insipidus(DI)/Primary polydipsia ruled out'''}}
{{Family tree | | | | | | | | | | C01 | | | | C02 |C01=Polyuria confirmed|C02=No polyuria/ or >800 mOsm/kg}}
{{family tree | | | | | | | | | | |!| | | | | |!}}
{{family tree | | | | | | | | | | D01 | | | | D02 | | | |D01='''Measure urine osmolality'''|D02='''Diabetes insipidus(DI)/Primary polydipsia ruled out'''}}
{{family tree | | | | | | | | | | |!| | | | | | }}
{{family tree | | | | | | | | | | |!| | | | | | }}
{{Family tree | | | | | | | | | | D01 | | | | | | |D01=(<800 mOsm/kg):<br>'''Hypotonic polyuria confirmed:'''<br>Measure serum Sodium and plasma osmolality}}                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
{{Family tree | | | | | | | | | | E01 | | | | | | |E01=<800 mOsm/kg}}                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
{{Family tree | | | | | | | | | | |!| | | | | | }}
{{Family tree | | | | | | | | | | F01 | | | | | |F01='''Hypotonic polyuria confirmed'''}}
{{Family tree | | | | | | | | | | |!| | | | | | }}
{{Family tree | | | | | | | | | | G01 | | | | | |G01=Measure serum Sodium and plasma osmolality}}
{{Family tree | | | | | | | | | | |!| | | | | | }}
{{Family tree | | | | | | | | | | |!| | | | | | }}
{{Family tree | | | | | | |,|-|-|-|^|-|-|v|-|-|-|-|-|.| | | }}
{{Family tree | | | | | | |,|-|-|-|^|-|-|v|-|-|-|-|-|.| | | }}
{{Family tree | | | | | | E01 | | | | | E02 | | | | E03 | |E01=Low normal or low serum Sodium (<150 mmol/L), plasma osmolality (<280 mOsm/kg):<br>'''Primary polydipsia'''| E02=Normal serum Sodium/plasma osmolality:<br>'''Indeterminate diagnosis'''| E03=High serum Sodium (>146 mmol/L), plasma osmolality (>300 mOsm/kg):<br>'''Central or Nephrogenic DI'''}}
{{Family tree | | | | | | H01 | | | | | H02 | | | | H03 | |H01=Low normal or low serum Sodium <150 mmol/L, plasma osmolality <280 mOsm/kg| H02=Normal serum Sodium/plasma osmolality|H03=High serum Sodium >146 mmol/L, plasma osmolality >300 mOsm/kg}}
{{Family tree | | | | | | |!| | | | | | |!| | | | | |!| | }}
{{Family tree | | | | | | I01 | | | | | I02 | | | | I03 | | | | |I01='''Primary polydipsia'''|I02='''Indeterminate diagnosis'''|I03='''Central or Nephrogenic DI'''}}
{{Family tree | | | | | | | | | | | | | |!| | | | | |!| | }}
{{Family tree | | | | | | | | | | | | | |!| | | | | |!| | }}
{{Family tree | | | | | | | | | | | | | |)|-|-|-|-|-|'| | }}
{{Family tree | | | | | | | | | | | | | |)|-|-|-|-|-|'| | }}
{{Family tree | | | | | | | | | | | | | |!| | | | | | | | }}
{{Family tree | | | | | | | | | | | | | |!| | | | | | | | }}
{{Family tree | | | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|.| | | | }}
{{Family tree | | | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|.| | | | }}
{{Family tree | | | | | F01 | | | | | | F02 | | | | F03 |-|-|-|-|-|.| |F01=Water deprivation test|F02=Baseline plasma copeptin|F03=Hypertonic saline infusion test}}
{{Family tree | | | | | J01 | | | | | | J02 | | | | J03 |-|-|-|-|-|.| |J01='''Water deprivation test'''|J02='''Baseline plasma copeptin'''|J03='''Hypertonic saline infusion test'''}}
{{Family tree | | |,|-|-|+|-|-|.| | | | |!| | | |,|-|^|-|.| | | | |!| | }}
{{Family tree | | |,|-|-|+|-|-|.| | | | |!| | | |,|-|^|-|.| | | | |!| | }}
{{Family tree | G01 | | G02 | | G03 | | |!| | | G04 | | G05 | | | |!| |G01=Urine Osm >800 mOsm/kg|G02=Urine Osm <300 mOsm/kg|G03=Urine Osm 300-800 mOsm/kg|G04=Plasma coprptin >4.9pmol/L|G05=Plasma coprptin <4.9pmol/L}}
{{Family tree | K01 | | K02 | | K03 | | |!| | | K04 | | K05 | | | |!| |K01=Urine Osm >800 mOsm/kg|K02=Urine Osm <300 mOsm/kg|K03=Urine Osm 300-800 mOsm/kg|K04=Plasma coprptin >4.9pmol/L|K05=Plasma coprptin <4.9pmol/L}}
{{Family tree | |!| | | |!| | | |!| |,|-|^|-|v|-|-|-|.| | | | | | |!| }}
{{Family tree | |!| | | |!| | | |!| |,|-|^|-|v|-|-|-|.| | | | | | |!| }}
{{Family tree | H01 | | H02 |-|-|'| H03 | | H04 | | H05 |-|-|-|-|-|'| |H01='''Mild primary polyuria'''|H02='''Desmopressin administration'''|H03='''>21pmol/L'''|H04='''<2.6pmol/L'''|H05='''>2.6pmol/L'''}}
{{Family tree | L01 | | L02 |-|-|'| L03 | | L04 | | L05 |-|-|-|-|-|'| |L01='''Mild primary polyuria'''|L02='''Desmopressin administration'''|L03='''>21pmol/L'''|L04='''<2.6pmol/L'''|L05='''>2.6pmol/L'''}}
{{Family tree | |,|-|-|-|^|-|.| | | |!| | | |!| | | }}
{{Family tree | |,|-|-|-|^|-|.| | | |!| | | |!| | | }}
{{Family tree | |!| | | | | I01 | | I02 | | I03 | | | | | | | |I01=(Urine Osmolality: 300-800 mOsm/Kg and <50% increase):<br>'''Therapeutic trial with desmopressin'''|I02='''Nephrogenic DI(partial or complete)'''|I03='''Complete Central DI'''}}
{{Family tree | |!| | | | | M01 | | M02 | | M03 | | | | | | | |M01=Urine Osmolality: 300-800 mOsm/Kg and <50% increase|M02='''Nephrogenic DI(partial or complete)'''|M03='''Complete Central DI'''}}
{{Family tree | |!| | | | | |!| | | | | | | | | | | | | }}
{{Family tree | |!| | | | | N01 | | | | | | | | | | | |N01='''Therapeutic trial with desmopressin'''}}
{{Family tree | |!| | | |,|-|^|-|v|-|-|-|.| | | | | | | | | | | }}
{{Family tree | |!| | | |,|-|^|-|v|-|-|-|.| | | | | | | | | | | }}
{{Family tree | |!| | | J01 | | J02 | | J03 | | | | | |J01='''Primary polydipsia'''|J02='''Partial Nephrogenic DI'''|J03='''Partial Central DI'''}}
{{Family tree | |!| | | O01 | | O02 | | O03 | | | | | |O01='''Primary polydipsia'''|O02='''Partial Nephrogenic DI'''|O03='''Partial Central DI'''}}
{{Family tree |,|^|-|-|-|.| | | }}
{{Family tree |,|^|-|-|-|.| | | }}
{{Family tree | K01 | | K02 | | | | | | | |K01=(Initial urine osmolality: 30 mOsm/kg and >50% increase after desmopressin):<br>'''Complete Central DI'''| K02=(Urine osmolality <300 mOsm/kg or <50% increase):<br>'''Complete Nephrogenic DI'''}}
{{Family tree | P01 | | P02 | | | | | | | |P01=Initial urine osmolality: 30 mOsm/kg and >50% increase after desmopressin:|P02=Urine osmolality <300 mOsm/kg or <50% increase}}
{{Family tree | |!| | | |!| | | | | | | | | | | | | | }}
{{Family tree | Q01 | | Q02 | | | | | | | | | | | | |Q01='''Complete Central DI'''|Q02='''Complete Nephrogenic DI'''}}
{{Family tree/end}}
{{Family tree/end}}


==Do's==
===Polyuria===
Shown below algorithm for the diagnostic approach to polyuria based on the American Journal of Kidney Diseases.
 
{{familytree/start}}
{{familytree | | | | | | | | | A01 | | | | | |A01='''Polyuria'''<br>'''(Urine Output > 3L/d)'''<ref name="pmid26687922">{{cite journal| author=Bhasin B, Velez JC| title=Evaluation of Polyuria: The Roles of Solute Loading and Water Diuresis. | journal=Am J Kidney Dis | year= 2016 | volume= 67 | issue= 3 | pages= 507-11 | pmid=26687922 | doi=10.1053/j.ajkd.2015.10.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26687922  }} </ref>}}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | B01 | | | | | |B01='''Urine Osmolality'''}}
{{familytree | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }}
{{familytree | | C01 | | | | | C02 | | | | | C03 |C01=<div style="float: left; text-align: left;">'''Uosm <100mOsm/kg<br>(Water Diuresis)'''<br>*Psychogenic Polydipsia<br>*DI (central and nephrogenic)|C02=<div style="float: left; text-align: left;">'''Uosm =100-300mOsm (Mixed Polyuria)'''<br>*Partial DI(central and Nephrogenic)<br>*Simultaneous water and solute intake<br>*CKD|C03=<div style="float: left; text-align: left;">'''Uosm >300mOsm/kg<br>(Solute Diuresis)'''<br>*Hyperglycemia<br>*Azotemia<br>*High solute intake<br>intravenous fluids<br>enteral and parenteral nutrition<br>Exogenous supplements
}}
{{familytree | | |!| | | | | | |!| | | | | | |!| }}
{{familytree | | |!|,|-|-|-|-|-|^|-|-|-|-|-|.|!| | | | }}
{{familytree | | D01 | | | | | | | | | | | D02 | |D01='''Water Deprivation Test'''|D02=<div style="float: left; text-align: left;">'''24-Hour Urine Collection'''<br>'''(estimation of osmoles)'''<br>*Urine sodium<br>*Urine potassium<br>*Urine glucose<br>*Urine urea nitrogen<br>*Other osmoles}}
{{familytree/end}}


==Don'ts==
==Treatment==
The management of polyuria depends on the underlying cause. Click on each [[disease]] shown below to see detailed management for every [[cause]] of polyuria.
*[[Psychogenic polydipsia medical therapy|Psychogenic polydipsia]]
*[[Diabetes insipidus medical therapy|Diabetes insipidus]]
*[[Nephrogenic diabetes insipidus medical therapy|Nephrogenic diabetes insipidus]]
*[[Diabetes mellitus type 1 medical therapy|Diabetes mellitus type 1]]
*[[Diabetes mellitus type 2 medical therapy|Diabetes mellitus type 2]]


==Do's==
* Recommend diet modification, like avoiding any food that irritates the bladder including caffeine, [[alcohol]], carbonated drinks, tomato-based products, chocolate, artificial sweeteners, and spicy foods.
* Monitor fluid food intake, drink enough to prevent constipation and over-concentration of [[urine]], and avoid drinking just before bedtime.
* Recommend Kegel exercises to strengthen the muscles around the [[bladder]] and [[urethra]].
==References==
==References==
{{Reflist|2}}
[[Category:Nephrology]]
[[Category:needs review]]

Latest revision as of 04:18, 31 July 2021

Polyuria Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zaida Obeidat, M.D.

Synonyms and keywords: Approach to polyuria, Approach to dilute urine, Polyuria management, Polyuria work-up

Overview

Causes

Life Threatening Causes

  • Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
  • Polyuria does not have life-threatening causes.

Common causes [2] [3]

Approach to Polyuria

Shown below is an algorithm summarizing the approach to polyuria.
Abbreviations: DI: Diabetes insipidus;

Hypotonic Polyuria

 
 
 
 
 
 
 
 
 
 
 
 
Suspected hypotonic polyuria[4]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Confirm presence of polyuria
>50ml/kg/24hrs or >3-4L/day
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Polyuria confirmed
 
 
 
No polyuria/ or >800 mOsm/kg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Measure urine osmolality
 
 
 
Diabetes insipidus(DI)/Primary polydipsia ruled out
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
<800 mOsm/kg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypotonic polyuria confirmed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Measure serum Sodium and plasma osmolality
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low normal or low serum Sodium <150 mmol/L, plasma osmolality <280 mOsm/kg
 
 
 
 
Normal serum Sodium/plasma osmolality
 
 
 
High serum Sodium >146 mmol/L, plasma osmolality >300 mOsm/kg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary polydipsia
 
 
 
 
Indeterminate diagnosis
 
 
 
Central or Nephrogenic DI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Water deprivation test
 
 
 
 
 
Baseline plasma copeptin
 
 
 
Hypertonic saline infusion test
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine Osm >800 mOsm/kg
 
Urine Osm <300 mOsm/kg
 
Urine Osm 300-800 mOsm/kg
 
 
 
 
 
 
Plasma coprptin >4.9pmol/L
 
Plasma coprptin <4.9pmol/L
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mild primary polyuria
 
Desmopressin administration
 
 
 
 
>21pmol/L
 
<2.6pmol/L
 
>2.6pmol/L
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine Osmolality: 300-800 mOsm/Kg and <50% increase
 
Nephrogenic DI(partial or complete)
 
Complete Central DI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Therapeutic trial with desmopressin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary polydipsia
 
Partial Nephrogenic DI
 
Partial Central DI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Initial urine osmolality: 30 mOsm/kg and >50% increase after desmopressin:
 
Urine osmolality <300 mOsm/kg or <50% increase
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Complete Central DI
 
Complete Nephrogenic DI
 
 
 
 
 
 
 
 
 
 
 
 

Polyuria

Shown below algorithm for the diagnostic approach to polyuria based on the American Journal of Kidney Diseases.

 
 
 
 
 
 
 
 
Polyuria
(Urine Output > 3L/d)[5]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Urine Osmolality
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Uosm <100mOsm/kg
(Water Diuresis)
*Psychogenic Polydipsia
*DI (central and nephrogenic)
 
 
 
 
Uosm =100-300mOsm (Mixed Polyuria)
*Partial DI(central and Nephrogenic)
*Simultaneous water and solute intake
*CKD
 
 
 
 
Uosm >300mOsm/kg
(Solute Diuresis)
*Hyperglycemia
*Azotemia
*High solute intake
intravenous fluids
enteral and parenteral nutrition
Exogenous supplements
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Water Deprivation Test
 
 
 
 
 
 
 
 
 
 
24-Hour Urine Collection
(estimation of osmoles)
*Urine sodium
*Urine potassium
*Urine glucose
*Urine urea nitrogen
*Other osmoles
 

Treatment

The management of polyuria depends on the underlying cause. Click on each disease shown below to see detailed management for every cause of polyuria.

Do's

  • Recommend diet modification, like avoiding any food that irritates the bladder including caffeine, alcohol, carbonated drinks, tomato-based products, chocolate, artificial sweeteners, and spicy foods.
  • Monitor fluid food intake, drink enough to prevent constipation and over-concentration of urine, and avoid drinking just before bedtime.
  • Recommend Kegel exercises to strengthen the muscles around the bladder and urethra.

References

  1. ↑ Moore K, Thompson C, Trainer P (2003). "Disorders of water balance". Clin Med (Lond). 3 (1): 28–33. doi:10.7861/clinmedicine.3-1-28. PMC 4953350. PMID 12617410.
  2. ↑ Wieliczko M, Matuszkiewicz-Rowińska J (2013). "[Polyuria]". Wiad Lek. 66 (4): 324–8. PMID 24490488.
  3. ↑ Weiss JP, Everaert K (2019). "Management of Nocturia and Nocturnal Polyuria". Urology. 133S: 24–33. doi:10.1016/j.urology.2019.09.022. PMID 31586470.
  4. ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dungan K; et al. (2000). "Endotext". PMID 30779536.
  5. ↑ Bhasin B, Velez JC (2016). "Evaluation of Polyuria: The Roles of Solute Loading and Water Diuresis". Am J Kidney Dis. 67 (3): 507–11. doi:10.1053/j.ajkd.2015.10.021. PMID 26687922.
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