Diabetes insipidus laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
There are a couple of laboratory investigations that can be carried out in order to diagnose diabetes insipidus. Some of them include plasma sodium and urine osmolality, measurement of urine output, plasma and urine ADH measurement. | There are a couple of laboratory investigations that can be carried out in order to diagnose diabetes insipidus. Some of them include plasma sodium and [[urine osmolality]], measurement of urine output, plasma and urine [[ADH]] measurement. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
Measurement of the plasma sodium concentration and the urine osmolality is helpful in distinguishing between the 3 types of Diabetes insipidus. Each of the three causes of polyuria – primary polydipsia, central DI, and nephrogenic DI – is associated with an increase in water output and the excretion of a relatively dilute urine. In primary polydipsia, the polyuria is an appropriate response to enhanced water intake but on the contrary the water loss is inappropriate with central and nephrogenic DI.<ref name="pmid10820168">{{cite journal |vauthors=Arthus MF, Lonergan M, Crumley MJ, Naumova AK, Morin D, De Marco LA, Kaplan BS, Robertson GL, Sasaki S, Morgan K, Bichet DG, Fujiwara TM |title=Report of 33 novel AVPR2 mutations and analysis of 117 families with X-linked nephrogenic diabetes insipidus |journal=J. Am. Soc. Nephrol. |volume=11 |issue=6 |pages=1044–54 |year=2000 |pmid=10820168 |doi= |url=}}</ref> | Measurement of the plasma sodium concentration and the urine [[osmolality]] is helpful in distinguishing between the 3 types of Diabetes insipidus. Each of the three causes of [[polyuria]] – primary [[polydipsia]], [[Central diabetes insipidus|central DI]], and [[Nephrogenic diabetes insipidus|nephrogenic DI]] – is associated with an increase in water output and the excretion of a relatively dilute urine. In primary [[polydipsia]], the [[polyuria]] is an appropriate response to enhanced water intake but on the contrary the water loss is inappropriate with [[central]] and [[Nephrogenic diabetes insipidus|nephrogenic DI]].<ref name="pmid10820168">{{cite journal |vauthors=Arthus MF, Lonergan M, Crumley MJ, Naumova AK, Morin D, De Marco LA, Kaplan BS, Robertson GL, Sasaki S, Morgan K, Bichet DG, Fujiwara TM |title=Report of 33 novel AVPR2 mutations and analysis of 117 families with X-linked nephrogenic diabetes insipidus |journal=J. Am. Soc. Nephrol. |volume=11 |issue=6 |pages=1044–54 |year=2000 |pmid=10820168 |doi= |url=}}</ref> Some of the investigations that can be done to appropriately diagnose diabetes insipidus are; | ||
Some of the investigations that can be done to appropriately diagnose | |||
'''Plasma sodium and urine osmolality'''; | '''Plasma sodium and [[urine osmolality]]'''; | ||
*Plasma sodium concentration (less than 137 meq/L) with a low urine osmolality (eg, less than one-half the plasma osmolality) is usually indicative of water overload due to primary polydipsia | *Plasma sodium concentration (less than 137 meq/L) with a low [[urine osmolality]] (eg, less than one-half the [[plasma osmolality]]) is usually indicative of water overload due to primary [[polydipsia]] | ||
*A high-normal plasma sodium concentration (greater than 142 meq/L, due to water loss) points toward | *A high-normal plasma sodium concentration (greater than 142 meq/L, due to water loss) points toward diabetes insipidus, particularly if the [[urine osmolality]] is less than the [[plasma osmolality]]. | ||
'''Measurement of urine output'''; | '''Measurement of urine output'''; | ||
* Clarity and usefulness of the sample collection is uncertain. | * Clarity and usefulness of the sample collection is uncertain. | ||
'''Water restriction test'''; | '''Water restriction test'''; | ||
*Water restriction or the administration of hypertonic saline (0.05 mL/kg per min for no more than two hours) can be used to differentiate central DI from primary polydipsia. | *Water restriction or the administration of [[Hypertonic|hypertonic saline]] (0.05 mL/kg per min for no more than two hours) can be used to differentiate [[Central diabetes insipidus|central DI]] from primary [[polydipsia]]. | ||
'''Plasma and urine ADH measurement'''<ref name="pmid7311993">{{cite journal |vauthors=Zerbe RL, Robertson GL |title=A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria |journal=N. Engl. J. Med. |volume=305 |issue=26 |pages=1539–46 |year=1981 |pmid=7311993 |doi=10.1056/NEJM198112243052601 |url=}}</ref><ref name="pmid11380498">{{cite journal |vauthors=Diederich S, Eckmanns T, Exner P, Al-Saadi N, Bähr V, Oelkers W |title=Differential diagnosis of polyuric/polydipsic syndromes with the aid of urinary vasopressin measurement in adults |journal=Clin. Endocrinol. (Oxf) |volume=54 |issue=5 |pages=665–71 |year=2001 |pmid=11380498 |doi= |url=}}</ref> | '''Plasma and urine ADH measurement'''<ref name="pmid7311993">{{cite journal |vauthors=Zerbe RL, Robertson GL |title=A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria |journal=N. Engl. J. Med. |volume=305 |issue=26 |pages=1539–46 |year=1981 |pmid=7311993 |doi=10.1056/NEJM198112243052601 |url=}}</ref><ref name="pmid11380498">{{cite journal |vauthors=Diederich S, Eckmanns T, Exner P, Al-Saadi N, Bähr V, Oelkers W |title=Differential diagnosis of polyuric/polydipsic syndromes with the aid of urinary vasopressin measurement in adults |journal=Clin. Endocrinol. (Oxf) |volume=54 |issue=5 |pages=665–71 |year=2001 |pmid=11380498 |doi= |url=}}</ref> | ||
*Rise in plasma/urine ADH in response to the rising plasma osmolality levels rules out Central DI | *Rise in plasma/urine [[ADH]] in response to the rising plasma [[osmolality]] levels rules out [[Central diabetes insipidus|central DI]] | ||
*An appropriate rise in urine osmolality as ADH secretion is increased rules out nephrogenic DI | *An appropriate rise in [[urine osmolality]] as [[ADH]] secretion is increased rules out [[Nephrogenic diabetes insipidus|nephrogenic DI]] | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
There are a couple of laboratory investigations that can be carried out in order to diagnose diabetes insipidus. Some of them include plasma sodium and urine osmolality, measurement of urine output, plasma and urine ADH measurement.
Laboratory Findings
Measurement of the plasma sodium concentration and the urine osmolality is helpful in distinguishing between the 3 types of Diabetes insipidus. Each of the three causes of polyuria – primary polydipsia, central DI, and nephrogenic DI – is associated with an increase in water output and the excretion of a relatively dilute urine. In primary polydipsia, the polyuria is an appropriate response to enhanced water intake but on the contrary the water loss is inappropriate with central and nephrogenic DI.[1] Some of the investigations that can be done to appropriately diagnose diabetes insipidus are;
Plasma sodium and urine osmolality;
- Plasma sodium concentration (less than 137 meq/L) with a low urine osmolality (eg, less than one-half the plasma osmolality) is usually indicative of water overload due to primary polydipsia
- A high-normal plasma sodium concentration (greater than 142 meq/L, due to water loss) points toward diabetes insipidus, particularly if the urine osmolality is less than the plasma osmolality.
Measurement of urine output;
- Clarity and usefulness of the sample collection is uncertain.
Water restriction test;
- Water restriction or the administration of hypertonic saline (0.05 mL/kg per min for no more than two hours) can be used to differentiate central DI from primary polydipsia.
Plasma and urine ADH measurement[2][3]
- Rise in plasma/urine ADH in response to the rising plasma osmolality levels rules out central DI
- An appropriate rise in urine osmolality as ADH secretion is increased rules out nephrogenic DI
References
- ↑ Arthus MF, Lonergan M, Crumley MJ, Naumova AK, Morin D, De Marco LA, Kaplan BS, Robertson GL, Sasaki S, Morgan K, Bichet DG, Fujiwara TM (2000). "Report of 33 novel AVPR2 mutations and analysis of 117 families with X-linked nephrogenic diabetes insipidus". J. Am. Soc. Nephrol. 11 (6): 1044–54. PMID 10820168.
- ↑ Zerbe RL, Robertson GL (1981). "A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria". N. Engl. J. Med. 305 (26): 1539–46. doi:10.1056/NEJM198112243052601. PMID 7311993.
- ↑ Diederich S, Eckmanns T, Exner P, Al-Saadi N, Bähr V, Oelkers W (2001). "Differential diagnosis of polyuric/polydipsic syndromes with the aid of urinary vasopressin measurement in adults". Clin. Endocrinol. (Oxf). 54 (5): 665–71. PMID 11380498.