Diabetes insipidus (patient information): Difference between revisions
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'''For the WikiDoc page for this topic, click [[Diabetes insipidus|here]]''' | '''For the WikiDoc page for this topic, click [[Diabetes insipidus|here]]''' | ||
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==Overview== | ==Overview== | ||
Diabetes insipidus (DI) is a rare disease that causes [[frequent urination]]. The large volume of urine is diluted, mostly water. To make up for lost water, a person with DI may feel the need to drink large amounts and is likely to urinate frequently, even at night, which can disrupt sleep and, on occasion, cause [[bedwetting]]. Because of the excretion of abnormally large volumes of dilute urine, people with DI may quickly become dehydrated if they do not drink enough water. Children with DI may be irritable or listless and may have [[fever]], [[vomiting]], or [[diarrhea]]. Milder forms of DI can be managed by drinking enough water, usually between 2 and 2.5 liters a day. DI severe enough to endanger a person’s health is rare. | Diabetes insipidus (DI) is a rare [[disease]] that causes [[frequent urination]]. The large volume of urine is diluted, mostly water. To make up for lost water, a person with DI may feel the need to drink large amounts and is likely to urinate frequently, even at night, which can disrupt sleep and, on occasion, cause [[bedwetting]]. Because of the excretion of abnormally large volumes of dilute urine, people with DI may quickly become dehydrated if they do not drink enough water. Children with DI may be [[irritable]] or listless and may have [[fever]], [[vomiting]], or [[diarrhea]]. Milder forms of DI can be managed by drinking enough water, usually between 2 and 2.5 liters a day. DI severe enough to endanger a person’s health is rare. | ||
==What are the symptoms of Diabetes insipidus?== | ==What are the symptoms of Diabetes insipidus?== | ||
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There are 4 Types of Diabetes insipidus | There are 4 Types of Diabetes insipidus | ||
===Central DI=== | ===Central DI=== | ||
The most common form of serious DI, central DI, 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. | The most common form of serious DI, [[Central diabetes insipidus|central DI]], 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|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 (pharmacology)|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 DI=== | ===Nephrogenic DI=== | ||
Nephrogenic DI results when the kidneys are unable to respond to ADH. The | [[Nephrogenic diabetes insipidus|Nephrogenic DI]] results when the [[Kidney|kidneys]] are unable to respond to [[ADH]]. The [[kidneys]]’ ability to respond to [[ADH]] can be impaired by [[Drugs (patient information)|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|nephrogenic DI]] is never discovered. [[Desmopressin]] will not work for this form of DI. Instead, a person with [[Nephrogenic diabetes insipidus|nephrogenic DI]] 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. | ||
Desmopressin will not work for this form of DI. Instead, a person with nephrogenic DI 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 DI=== | ===Dipsogenic DI=== | ||
Dipsogenic DI is caused by a defect in or damage to the thirst mechanism, which is located in the [[hypothalamus]]. This defect results in an abnormal increase in thirst and fluid intake that suppresses ADH secretion and increases urine output. Desmopressin or other drugs should not be used to treat dipsogenic DI because they may decrease urine output but not thirst and fluid intake. This fluid overload can lead to water intoxication, a condition that lowers the concentration of sodium in the blood and can seriously damage the brain. Scientists have not yet found an effective treatment for dipsogenic DI. | Dipsogenic DI is caused by a defect in or damage to the thirst mechanism, which is located in the [[hypothalamus]]. This defect results in an abnormal increase in thirst and fluid intake that suppresses [[ADH]] secretion and increases urine output. [[Desmopressin]] or other drugs should not be used to treat dipsogenic DI because they may decrease urine output but not thirst and fluid intake. This fluid overload can lead to [[water intoxication]], a condition that lowers the [[concentration]] of [[sodium]] in the [[blood]] and can seriously damage the [[brain]]. [[Scientists]] have not yet found an effective treatment for dipsogenic DI. | ||
===Gestational DI=== | ===Gestational DI=== | ||
Gestational DI occurs only during [[pregnancy]] and results when an enzyme made by the placenta destroys ADH in the mother. The placenta is the system of blood vessels and other tissue that develops with the fetus. The placenta allows exchange of nutrients and waste products between mother and fetus.Most cases of gestational DI can be treated with desmopressin. In rare cases, however, an abnormality in the thirst mechanism causes gestational DI, and desmopressin should not be used. | Gestational DI occurs only during [[pregnancy]] and results when an [[enzyme]] made by the [[placenta]] destroys [[ADH]] in the mother. The placenta is the system of blood vessels and other tissue that develops with the [[fetus]]. The placenta allows exchange of nutrients and waste products between mother and fetus.Most cases of gestational DI can be treated with [[desmopressin]]. In rare cases, however, an abnormality in the thirst mechanism causes gestational DI, and [[desmopressin]] should not be used. | ||
==Who is at highest risk?== | ==Who is at highest risk?== | ||
Nephrogenic diabetes insipidus presenting at or shortly after birth can have a genetic cause. It usually affects males, though women can be a carrier and pass the gene on to their children. | [[Nephrogenic diabetes insipidus]] presenting at or shortly after birth can have a [[Genetics|genetic]] cause. It usually affects males, though women can be a carrier and pass the [[gene]] on to their children. | ||
==When to seek urgent medical care?== | ==When to seek urgent medical care?== | ||
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==Diagnosis== | ==Diagnosis== | ||
Because | Because [[diabetes mellitus]] is more common and because [[diabetes mellitus]] (DM) and [[Diabetes insipidus|diabetes insipidus (DI)]] have similar symptoms, a [[health care provider]] may suspect that a [[patient]] with [[Diabetes insipidus|DI]] has [[DM]]. But testing should make the diagnosis clear.A doctor must determine which type of [[DI]] is involved before proper treatment can begin. Diagnosis is based on a series of tests, including '''urinalysis''' and a '''fluid deprivation test.''' | ||
*'''[[Urinalysis]]''': is the physical and chemical examination of urine. The urine of a person with DI will be less concentrated. Therefore, the salt and waste concentrations are low and the amount of water excreted is high. A physician evaluates the concentration of urine by measuring how many particles are in a kilogram of water or by comparing the weight of the urine with an equal volume of distilled water. | *'''[[Urinalysis]]''': is the physical and chemical examination of [[urine]]. The [[urine]] of a person with [[DI]] will be less concentrated. Therefore, the [[salt]] and waste concentrations are low and the amount of water excreted is high. A physician evaluates the concentration of [[urine]] by measuring how many particles are in a kilogram of water or by comparing the weight of the urine with an equal volume of distilled water. | ||
*'''Fluid deprivation test''': helps determine whether DI is caused by one of the following: | *'''[[Fluid deprivation test]]''': helps determine whether [[Diabetes insipidus|DI]] is caused by one of the following: | ||
* excessive intake of fluid | * excessive intake of fluid | ||
* a defect in ADH production | * a defect in [[ADH]] production | ||
* a defect in the | * a defect in the [[kidneys]]’ response to [[ADH]] | ||
This test measures changes in body weight, urine output, and urine composition when fluids are withheld. Sometimes measuring blood levels of ADH during this test is also necessary. In some patients, a [[magnetic resonance imaging]] ([[MRI]]) of the brain may be necessary as well. | This test measures changes in body weight, urine output, and urine composition when fluids are withheld. Sometimes measuring blood levels of [[ADH]] during this test is also necessary. In some patients, a [[magnetic resonance imaging]] ([[MRI]]) of the brain may be necessary as well. | ||
==Treatment options== | ==Treatment options== | ||
*'''Central DI''' is caused by damage to the [[pituitary gland]] and is treated with a synthetic hormone called [[desmopressin]], which prevents water excretion. | *'''[[Central diabetes insipidus|Central DI]]''' is caused by damage to the [[pituitary gland]] and is treated with a synthetic hormone called [[desmopressin]], which prevents water [[excretion]]. | ||
*'''Nephrogenic DI''' is caused by drugs or kidney disease and is treated with [[hydrochlorothiazide]] (HCTZ), [[indomethacin]], or a combination of HCTZ and [[amiloride]]. | *'''[[Nephrogenic diabetes insipidus|Nephrogenic DI]]''' is caused by [[drugs]] or [[kidney disease]] and is treated with [[hydrochlorothiazide]] (HCTZ), [[indomethacin]], or a combination of HCTZ and [[amiloride]]. | ||
*Scientists have not yet discovered an effective treatment for '''dipsogenic DI''', which is caused by a defect in the thirst mechanism. | *Scientists have not yet discovered an effective treatment for '''dipsogenic DI''', which is caused by a defect in the thirst mechanism. | ||
*Most forms of '''gestational DI''' can be treated with desmopressin. | *Most forms of '''gestational DI''' can be treated with [[desmopressin]]. | ||
*A doctor must determine which type of DI is involved before proper treatment can begin. | *A doctor must determine which type of [[Diabetes insipidus|DI]] is involved before proper treatment can begin. | ||
==Where to find medical care for Diabetes insipidus?== | ==Where to find medical care for Diabetes insipidus?== | ||
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==What to expect (Outlook/Prognosis)?== | ==What to expect (Outlook/Prognosis)?== | ||
The outcome depends on the underlying disorder. If treated, diabetes insipidus does not cause severe problems or reduce life expectancy. | The outcome depends on the underlying disorder. If treated, [[diabetes insipidus]] does not cause severe problems or reduce life expectancy. | ||
==Possible complications== | ==Possible complications== | ||
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Not drinking enough fluids can lead to the following complications: | Not drinking enough fluids can lead to the following complications: | ||
*Dehydration | *[[Dehydration]] | ||
*Dry skin | *Dry skin | ||
*Dry mucus membranes | *Dry [[mucus membranes]] | ||
*Fever | *[[Fever]] | ||
*Rapid heart rate | *[[Tachycardia|Rapid heart rate]] | ||
*Sunken appearance to eyes | *Sunken appearance to eyes | ||
*Sunken fontanelles (soft spot) in infants | *Sunken [[fontanelles]] (soft spot) in infants | ||
*Unintentional weight loss | *Unintentional [[weight loss]] | ||
*Electrolyte imbalance | *[[Electrolyte imbalance]] | ||
*Fatigue, lethargy | *[[Fatigue]], [[lethargy]] | ||
*Headache | *[[Headache]] | ||
*Irritability | *[[Irritability]] | ||
*Muscle pains | *[[Muscle pains]] | ||
==Sources== | ==Sources== | ||
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[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
[[Category:Nephrology]] | [[Category:Nephrology]] | ||
Latest revision as of 13:54, 14 July 2017
For the WikiDoc page for this topic, click here
|
Diabetes insipidus |
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Diabetes insipidus On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jinhui Wu, M.D.
Overview
Diabetes insipidus (DI) is a rare disease that causes frequent urination. The large volume of urine is diluted, mostly water. To make up for lost water, a person with DI may feel the need to drink large amounts and is likely to urinate frequently, even at night, which can disrupt sleep and, on occasion, cause bedwetting. Because of the excretion of abnormally large volumes of dilute urine, people with DI may quickly become dehydrated if they do not drink enough water. Children with DI may be irritable or listless and may have fever, vomiting, or diarrhea. Milder forms of DI can be managed by drinking enough water, usually between 2 and 2.5 liters a day. DI severe enough to endanger a person’s health is rare.
What are the symptoms of Diabetes insipidus?
- Excessive thirst and intake of fluids
- Excessive urination
- Bedwetting
- Waking up in the middle of the night to urinate
- Diabetes mellitus can also present with similar symptoms.
What causes Diabetes insipidus?
There are 4 Types of Diabetes insipidus
Central DI
The most common form of serious DI, central DI, 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 DI
Nephrogenic DI 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 DI is never discovered. Desmopressin will not work for this form of DI. Instead, a person with nephrogenic DI 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 DI
Dipsogenic DI is caused by a defect in or damage to the thirst mechanism, which is located in the hypothalamus. This defect results in an abnormal increase in thirst and fluid intake that suppresses ADH secretion and increases urine output. Desmopressin or other drugs should not be used to treat dipsogenic DI because they may decrease urine output but not thirst and fluid intake. This fluid overload can lead to water intoxication, a condition that lowers the concentration of sodium in the blood and can seriously damage the brain. Scientists have not yet found an effective treatment for dipsogenic DI.
Gestational DI
Gestational DI occurs only during pregnancy and results when an enzyme made by the placenta destroys ADH in the mother. The placenta is the system of blood vessels and other tissue that develops with the fetus. The placenta allows exchange of nutrients and waste products between mother and fetus.Most cases of gestational DI can be treated with desmopressin. In rare cases, however, an abnormality in the thirst mechanism causes gestational DI, and desmopressin should not be used.
Who is at highest risk?
Nephrogenic diabetes insipidus presenting at or shortly after birth can have a genetic cause. It usually affects males, though women can be a carrier and pass the gene on to their children.
When to seek urgent medical care?
Tell your doctor if you are experiencing any of the symptoms associated with diabetes insipidus.
Diagnosis
Because diabetes mellitus is more common and because diabetes mellitus (DM) and diabetes insipidus (DI) have similar symptoms, a health care provider may suspect that a patient with DI has DM. But testing should make the diagnosis clear.A doctor must determine which type of DI is involved before proper treatment can begin. Diagnosis is based on a series of tests, including urinalysis and a fluid deprivation test.
- Urinalysis: is the physical and chemical examination of urine. The urine of a person with DI will be less concentrated. Therefore, the salt and waste concentrations are low and the amount of water excreted is high. A physician evaluates the concentration of urine by measuring how many particles are in a kilogram of water or by comparing the weight of the urine with an equal volume of distilled water.
- Fluid deprivation test: helps determine whether DI is caused by one of the following:
- excessive intake of fluid
- a defect in ADH production
- a defect in the kidneys’ response to ADH
This test measures changes in body weight, urine output, and urine composition when fluids are withheld. Sometimes measuring blood levels of ADH during this test is also necessary. In some patients, a magnetic resonance imaging (MRI) of the brain may be necessary as well.
Treatment options
- Central DI is caused by damage to the pituitary gland and is treated with a synthetic hormone called desmopressin, which prevents water excretion.
- Nephrogenic DI is caused by drugs or kidney disease and is treated with hydrochlorothiazide (HCTZ), indomethacin, or a combination of HCTZ and amiloride.
- Scientists have not yet discovered an effective treatment for dipsogenic DI, which is caused by a defect in the thirst mechanism.
- Most forms of gestational DI can be treated with desmopressin.
- A doctor must determine which type of DI is involved before proper treatment can begin.
Where to find medical care for Diabetes insipidus?
Directions to Hospitals Treating Diabetes insipidus
What to expect (Outlook/Prognosis)?
The outcome depends on the underlying disorder. If treated, diabetes insipidus does not cause severe problems or reduce life expectancy.
Possible complications
If thirst mechanisms are normal and you drink enough fluids, there are no significant effects on body fluid or salt balance.
Not drinking enough fluids can lead to the following complications:
- Dehydration
- Dry skin
- Dry mucus membranes
- Fever
- Rapid heart rate
- Sunken appearance to eyes
- Sunken fontanelles (soft spot) in infants
- Unintentional weight loss
- Electrolyte imbalance
- Fatigue, lethargy
- Headache
- Irritability
- Muscle pains