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Diabetes Insipidus

Definition


Disease: Diabetes Insipidus Diabetes Insipidus
Category: Endocrine and metabolic diseases

Disease Definition:

Intense thirst and the excretion of large amounts of urine (polyuria) are the hallmarks of diabetes insipidus (DI). Even though diabetes insipidus can occur when a person’s kidneys are not able to respond to a key hormone, but it usually occurs as a result of the body’s inability to properly produce, store or release that key hormone. Gestational diabetes insipidus is when this condition occurs during pregnancy, but is quite rare.

 

Diabetes mellitus (type 1 and type 2) and diabetes insipidus are not the same despite the fact that they share some common signs. In order to normalize the urine output and relieve thirst, effective treatments are available.
 

Work Group:


Symptoms, Causes

Symptoms:

As mentioned before, excretion of an excessive volume of diluted urine and extreme thirst are the most common signs and symptoms of diabetes insipidus. Bed-wetting and needing to get up at night to urinate, a condition called nocturia, are some of the other signs and symptoms of this condition.

 

A healthy adult may have an average urine output of 1.5 to 2.5 liters (1.6 to 2.6 quarts) a day.  While the urine output of a person with diabetes insipidus may range from about 2.5 liters (2.6 quarts) to about 15 liters (16 quarts), in case the condition is severe and the person is taking in a lot of fluids. Listed below are the signs and symptoms of infants and young children with diabetes insipidus:

  • Fever, diarrhea or vomiting
  • Weight loss
  • Inconsolable crying or unexplained fussiness
  • Delayed growth
  • Unusually wet diapers
  • Dry skin with cool extremities

 

In case someone notices the two most common signs of diabetes insipidus, which are extreme thirst and excessive urination, a doctor should be immediately contacted.
 

Causes:

Usually, excess body fluids are removed from the bloodstream through the kidneys and fluid waste is stored as urine in the bladder.
If the fluid regulating system is working properly, the kidneys will make less urine when the water in the body decreases like in perspiration. This is done to save fluids. A combination of oral intake and excretion in the kidneys keep the volume and composition of the body fluids balanced. Thirst controls a person’s rate of fluid intake, but his/her habits could increase the volume of fluid intake more than the needed amount. The production of anti-diuretic hormone (ADH), also called vasopressin, greatly influences the rate of fluid excreted by the kidneys.

 

The ADH hormone is made in the hypothalamus and stored in the pituitary gland, which is a small gland found in the base of the brain. Whenever necessary, the ADH hormone is released into the bloodstream. After that, instead of excreting the water into the urine, the ADH triggers the kidney tubules to reabsorb it back into the bloodstream, and thus it concentrates the urine. When this system becomes disrupted and the body can no longer regulate how it handles fluids, diabetes insipidus occurs. Which of the forms of diabetes a person has will be determined by the way in which his/her system is disrupted:

 

Nephrogenic diabetes insipidus:

When there’s a defect in the structures in the kidneys called the kidney tubules that cause water to be excreted or reabsorbed, nephrogenic diabetes insipidus occurs. The kidneys won’t be able to properly respond to ADH because of this defect. A chronic kidney disorder or a genetic (inherited) disorder may be the cause of the defect mentioned above. Nephrogenic diabetes insipidus may also be due to certain drugs, such as tetracycline and lithium.

 

Central diabetes insipidus:

Damage to the pituitary gland or the hypothalamus usually as a result of surgery, an illness such as meningitis, a head injury, a tumor or an inflammation is the most common cause of central diabetes insipidus. The normal production, storage and release of ADH will be disrupted by this damage. However, the cause of this damage may not be known.

 

Gestational diabetes insipidus:

The placenta is the system of blood vessels and other tissue that allows the exchange of nutrients and waste products between a mother and her baby. During pregnancy, if an enzyme made by the placenta destroys ADH in the mother, gestational diabetes insipidus occurs.

 

The exact cause of diabetes insipidus isn’t found in about 30% of the cases.
 

Complications

Complications:

Diabetes insipidus can lead to dehydration through driving the body to hold back a poor amount of water to function properly. Some of the things that dehydration may cause include:

  • Hypernatremia
  • Rapid heart rate
  • Dry mouth
  • Sunken appearance to the eyes
  • Weight loss
  • Hypotension
  • Fever or headache, or both
  • Muscle weakness

 

An electrolyte imbalance may also be caused by diabetes insipidus. Electrolytes are minerals in the blood such as sodium, potassium, and calcium. Their main job is to preserve the balance of liquids in the body. Fatigue, muscle pains, headache and irritability are some of the symptoms that may result from any disorder to the balance of electrolytes.
 

Treatments:

Depending on the patient's condition, the doctor will determine which form of DI he/she has before beginning treatment. Treatment options for the common types of DI include the following:

 

Central diabetes insipidus:

This type of diabetes is treated with a synthetic hormone called desmopressin because a lack of the anti-diuretic hormone (ADH) is the main cause of this condition. Desmopressin will eliminate the increase in urination and it could be taken as oral tablets, a nasal spray or by injection. Desmopressin is a safe and effective treatment for most people with central DI. In case an abnormality in the hypothalamus or pituitary gland, such as a tumor, is the cause of central DI, then this abnormality will be treated first.

 

A person with central diabetes insipidus should make sure to replace any fluid that he/she lost. However, a person should only drink water or fluids when he/she is thirsty in the case of being prescribed desmopressin. In this case, the kidneys make less urine and are less responsive to changes in body fluids because desmopressin prevents the excess excretion of water. Maybe all a person needs in mild central DI cases is to increase the intake of fluids. However, to guarantee proper hydration, the doctor can advise an amount of water intake typically more than 2.5 liters (about 2.6 quarts) a day.

 

Gestational diabetes:

The synthetic hormone desmopressin is used in the treatment of most cases of gestational DI. This condition may be caused in some rare cases due to an abnormality in the thirst mechanism of a person. Desmopressin can’t be prescribed in these cases.

 

Nephrogenic diabetes insipidus:

When the kidneys can’t properly respond to ADH, nephrogenic DI occurs, a condition that can’t be treated with desmopressin. In order to help reduce the amount of urine the kidneys make, the patient may be prescribed a low-salt diet. Additionally, to avoid dehydration, the patient should drink adequate amounts of water.

 

The symptoms of nephrogenic diabetes insipidus can be improved with hydrochlorothiazide, which is a drug that can be used alone or with other medications. Even though hydrochlorothiazide is a diuretic (used to increase urine output), but it can decrease the urine output in some cases of nephrogenic DI. If the nephrogenic DI is due to medications, stopping these medications could help a great deal. However, a patient should never stop any medications without first asking his/her doctor.
 

Prognosis:

Not available

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