Polyuria resident survival guide
Overview
Causes
Life threatening causes
Common causes
The most common causes of Polyuria are: psychogenic polydipsia, diabetes insipidus (central and nephrogenic), chronic kidney disease and uncontrolled diabetes mellitus. [1]
Diagnosis
Approach to polyuria
| Polyuria ❑ 24-hour urine volume >3L ❑ 24-hour urine volume >50 ml/kg | |||||||||||||||||||||||||||||||||||
| Urine Osmolality >300mosmol | Urine Osmolality <300[2]mosmol | ||||||||||||||||||||||||||||||||||
| Solute diuresis ❑ Glucose ❑ Mannitol ❑ Contrast media ❑ High protein intake ❑ Diuretics ❑ Medullary cystic disease ❑ Resolving ATN ❑ Resolving obstruction | |||||||||||||||||||||||||||||||||||
| Water diuresis ❑ Primary polydipsia ❑ Diabetes inspidous | |||||||||||||||||||||||||||||||||||
| Water restriction test OR administration of hypertonic saline 0.05 mL/kg/min for 2 h | |||||||||||||||||||||||||||||||||||
| Water restriction test
❑ Overnight fluid restriction should be avoided ❑ Recommend the patient to stop drinking 2-3 hours before coming to clinic ❑ Meaure urine volume every hour ❑ Measure urine osmolality every hour ❑ Measure plasma sodium concentration every 2 hours ❑ Measure plasma osmolality every 2 hours | |||||||||||||||||||||||||||||||||||
| Test endpoints in adults: ❑ Urine osmolality reaches normal value (above 600 mosmol/kg) ❑ The urine osmolality is stable for 2 or 3 successive hourly measurements despite a rising plasma osmolality ❑ Plasma osmolality >295-300 mosmol/kg ❑ Plasma sodium is 145 or higher | |||||||||||||||||||||||||||||||||||
Treatment
Do's
Don'ts
References
- ↑ Wieliczko M, Matuszkiewicz-Rowińska J (2013). "[Polyuria]". Wiad Lek. 66 (4): 324–8. PMID 24490488.
- ↑ Robertson GL: Diabetes insipidus. Endocrinol Metab Clin North Am 24:549–572, 1995.