About Diabetes Insipidus | Endocrinology

Diabetes Insipidus

What is Diabetes insipidus (DI)?

Diabetes insipidus is a rare disorder that happens when a person’s kidneys pass an abnormally large capacity of tasteless, dilute, and odorless urine. In most people, the kidneys pass about 1 to 2 liters of urine a day. In people with DI, the kidneys can eliminate 3 to 20 liters of urine per day. As a result, a person with DI may feel the need to drink large amounts of fluids.

Diabetes insipidus and diabetes mellitus, which contain both type 1 and type 2 diabetes, are unrelated, although both conditions cause numerous urination and constant thirst. Diabetes mellitus causes high levels of blood glucose, or blood sugar, as a result of the body’s inability to use blood glucose for energy. People with DI have normal blood glucose levels; though, your kidneys cannot balance the fluids in your body.

Alternate name

  • Dipsogenic diabetes insipidus
  • DI

Types of Diabetes insipidus

Types of diabetes insipidus include:

  • Central
  • Nephrogenic
  • Dipsogenic
  • Gestational

Each kind of DI has a different cause.

Central diabetes insipidus

Central diabetes insipidus occurs when harm to a person’s hypothalamus or pituitary gland causes disturbances in the normal production, storage, and release of vasopressin. The alteration of vasopressin causes the kidneys to remove too much fluid from the body, causing increased urination. Damage to the hypothalamus or pituitary gland can outcome from the following:

  • Surgery
  • Infection
  • Inflammation
  • A tumor
  • Head injury

Central diabetes insipidus can also be due to an inherited defect in the gene that produces vasopressin, although this cause is rare. In some cases, the cause is unknown.

Nephrogenic diabetes insipidus

Nephrogenic diabetes insipidus happens when the kidneys do not react normally to vasopressin and continue to remove too much fluid from a person’s bloodstream. Nephrogenic diabetes insipidus can be the result of inherited genetic changes, or mutations, that prevent the kidneys from returning to vasopressin. Other causes of nephrogenic diabetes insipidus include

  • chronic kidney disease
  • certain medications, particularly lithium
  • low levels of potassium in the blood
  • high levels of calcium in the blood
  • urinary tract blockage

The causes of nephrogenic diabetes insipidus may also be unknown.

Dipsogenic diabetes insipidus

A flaw in the thirst mechanism, located in a person’s hypothalamus, causes dipsogenic diabetes insipidus. This defect results in an abnormal intensification in thirst and fluid intake that suppresses vasopressin secretion and increases urine output. The same actions and conditions that damage the hypothalamus or pituitary (surgery, infection, inflammation, a tumor, head injury) can also damage the dryness mechanism. Certain medications or mental health problems can predispose a person to dipsogenic diabetes insipidus.

Gestational diabetes insipidus

Gestational diabetes insipidus occurs only during pregnancy. In some cases, an enzyme produced by the placenta, a temporary organ that binds mother and baby, breaks down the mother’s vasopressin. In other circumstances, pregnant women make more prostaglandin, a hormone-like chemical that reduces the kidneys’ sensitivity to vasopressin. Most pregnant women who develop gestational diabetes insipidus have a mild case that causes no noticeable symptoms. Gestational diabetes insipidus usually goes away after the mother delivers the baby; however, it can recur if the mother becomes pregnant again.

Causes of Diabetes insipidus

Your body makes a hormone called vasopressin in a part of your brain called the hypothalamus. It is stored in your pituitary gland. Vasopressin tells your kidneys to retain water, which makes your urine more focused. (Vasopressin is also called antidiuretic hormone or ADH.)

When you are thirsty or slightly dehydrated, your vasopressin levels increase. The kidneys absorb more water and expel concentrated urine. If you’ve had enough to drink, vasopressin levels drop and what comes out is clear and dilute.

When your body doesn’t make sufficient vasopressin, the illness is called central diabetes insipidus. If you are making enough but your kidneys are not responding as they should, you have nephrogenic diabetes insipidus.

Either way, the result is the same. Your kidneys cannot retain water, so even if you are dehydrated, they will expel a lot of pale urine.

Risk factors for Diabetes insipidus

Nephrogenic diabetes insipidus that’s present at or shortly after birth typically has an inherited (genetic) because that permanently changes the kidneys’ ability to concentrate the urine. Nephrogenic diabetes insipidus frequently affects males, though women can permit the gene onto their children.

Symptoms of Diabetes insipidus

The signs and symptoms of diabetes insipidus include:

  • Extreme thirst
  • Produce large amounts of thin urine
  • The common need to get up to urinate at night
  • Preference for cold drinks

If your condition is severe, your urine output can be up to 20 quarts (about 19 liters) a day if you drink a lot of fluids. A healthy adult usually urinates an average of 1 to 2 quarts (about 1 to 2 liters) a day.

A baby or young child with DI may have the following signs and symptoms:

  • Wet and heavy diapers
  • Wet the bed
  • Trouble sleeping
  • Fever
  • Vomiting
  • Constipation
  • Stunted growth
  • Weightloss

Diagnosis of Diabetes insipidus

A healthcare provider can diagnose a person with diabetes insipidus founded on the following:

  • Medical and family history
  • Physical exam
  • Urine analysis
  • Blood test
  • Fluid deprivation test
  • Magnetic resonance imaging (MRI)

Medical and family history

Obtaining a medical and family history can help your doctor diagnose diabetes insipidus. A doctor will ask the patient to review their symptoms and ask if the patient’s family has a history of DI or its symptoms.

Physical exam

A physical exam can help diagnose DI. During a physical exam, a health care provider usually examines the patient’s skin and appearance for signs of dehydration.

Urine analysis

Urinalysis analyzes a urine sample. A patient collects the urine sample in a special container at home, at a healthcare provider’s office, or at a commercial facility. A healthcare provider tests the sample in the same place or sends it to a laboratory for analysis. The test can show whether the urine is thinned or concentrated. The test can also show the presence of glucose, which can differentiate between diabetes insipidus and diabetes mellitus. The healthcare provider may also ask the patient to collect urine in a special container over a 24-hour period to measure the total amount of urine produced by the kidneys.

Blood test

A blood test involves drawing blood from a patient in a healthcare provider’s office or commercial facility and sending the sample to a laboratory for analysis. The blood test actions sodium levels, which can help diagnose DI and, in some belongings, determine the type.

Fluid deprivation test

A fluid deprivation test measures changes in a patient’s body weight and urine concentration after restricting fluid intake. A healthcare provider can perform two types of fluid deprivation tests:

  • A short form of the deprivation test. A healthcare provider instructs the patient to stop drinking all fluids for a specified period of time, usually during dinner. The next morning, the patient will gather a urine sample at home. The patient then returns the urine sample to their healthcare provider or takes it to a laboratory where a technician measures the concentration of the urine sample.
  • A formal fluid deprivation test. A healthcare provider achieves this test in a hospital to incessantly monitor the patient for signs of dehydration. Patients do not need anesthesia. A doctor weighs the patient and analyzes a urine sample. The healthcare provider repeats the tests and measures the patient’s blood pressure each 1 to 2 hours till one of the following occurs:
  • The patient’s blood pressure drops too little or the patient has a rapid heartbeat when standup.
  • The patient loses 5 percent or more of his initial body weight.
  • The urine concentration increases only slightly in two or three consecutive measurements.

At the end of the test, a doctor will compare the patient’s blood sodium, vasopressin, and urine concentration levels to determine if the patient has diabetes insipidus. Occasionally the healthcare provider may manage medications during the test to see if they increase the patient’s urine concentration. In other cases, the doctor may give the patient a concentrated sodium solution intravenously at the end of the test to increase the patient’s blood sodium level and determine if they have diabetes insipidus.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) is a test that takes pictures of the internal organs and soft tissues of the body without using X-rays. A particularly trained technician performs the procedure in an outpatient center or hospital, and a radiologist, a doctor who specializes in medical imaging, understands images. A patient does not need anesthesia, although people with a fear of tight spaces may receive light sedation. An MRI scan may include an injection of a special dye, called contrast medium. With most MRI machines, the person lies on a table that slides into a tunnel-shaped device that can have one end open or one end closed. Some MRI machines allow the patient to lie down in a more open space. MRIs cannot diagnose DI. In its place, an MRI can show whether the patient has problems with their hypothalamus or pituitary gland or help the healthcare provider regulate if diabetes insipidus is the possible cause of the patient’s symptoms.

Treatment options for Diabetes insipidus

First, your doctor will tell you to drink lots of fluids. That will replace the constant loss of water. Other treatments depend on the type you have:

  • Central diabetes insipidus:¬†You will need to take medications such as desmopressin (DDAVP) or vasopressin (Pitressin). It typically comes in the procedure of a nasal spray. There are also actions to help these drugs work better.
  • Nephrogenic diabetes insipidus: It can be more difficult to treat. If it’s caused by a drug, stopping the drug helps. Other medications can relieve symptoms. These comprise indomethacin (Indocin) and diuretics like amiloride (Moduretic 5-50) or hydrochlorothiazide (Microzide). Although diuretics usually make you urinate more, in this case, they help you produce less urine. Occasionally this condition goes absent if you treat the cause.
  • Dipsogenic diabetes insipidus: There is no treatment for this condition. But some things can ease symptoms. Suck on ice chips or sour candy to moisten the mouth, increase saliva flow, and reduce the desire to drink. If you wake up to urinate several times at night, a small dose of desmopressin at bedtime may help.
  • Gestational diabetes insipidus: You can take desmopressin during pregnancy. Your problems should go away after you have the baby.

Prevention

There is no exact way to prevent diabetes insipidus. But, some preventive measures help avoid serious complications of the disease. They are:

  • Constant monitoring of urine output, if the patient has underlying brain tumors or kidney disease
  • Regular self-monitoring to check for signs of dehydration
  • Daily intake of low salt diet
  • Regular physical activity or yoga to maintain general health

Complications

Without medical treatment, possible complications of this disorder include:

  • Chronic dehydration
  • Low body temperature
  • Accelerated heart rate
  • Weightloss
  • Fatigue
  • Frequent headaches
  • Low blood pressure (hypotension)
  • Kidney damage
  • Brain damage
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