POLYURIA

COMMOMON CAUSES:
DEFINITION:
1. Diabetes mellitus
2. Diuretic therapy
3. Chronic renal failure
4. Compulsive water drinking
5. Hypercalcemia
6. Diabetes insipidus
7. Following defervescence of fever
8. Following an attack of supra-ventricular tachycardia
History of present illness:
1. Onset: - sudden, patient even remembering the time and the
date of onset of symptoms (Diabetes insipidus), Gradual
(Diabetes mellitus, chronic renal failure, hypercalcemia and
compulsive water drinking), under special circumstances
(Diabetic therapy, following defervescence of fever or an attack
pf supraventricular tachycardia)
2. Frequency of micturition: - How many times the patient passes
urine in 24 hours? this information can help to monitor the
progress of the patient but cannot help in diagnosis because
increased frequency of micturition can also occur due to
urinary tract infection, when in contrast to polyuria very small
quantities of urine are passed every time.
3. Time of urine passed: - During the day time
4. only (compulsive water intake), during day and night (All other
causes of polyuria).
5. Volume of urine passed: - Large volumes of urine passed every
time (polyuria), small volume of urine passed every time
(urinary tract infection or prostatism).
6. Type of fluid Taken: - Ice cold water (Diabetes insipidus), sweet
drinks (Diabetes mellitus), any type of fluid (All other causes of
polyuria).
7. Associated symptoms: -
a) Polydipsia, polyphagia, numbness, weakness, visual
disturbances and ants collecting at the urine (Diabetes
mellitus).
b) Headache and/or visual disturbance (Diabetes insipidus),
c) Anorexia, nausea, vomiting, diarrhoea, metallic taste in the
mouth, hiccough, pallor and breathlessness (chronic renal
failure).
d) Anorexia, nausea, vomiting, constipation and bone pains
(Hypercalcemia)
e) Symptoms disorder for which diuretics are being given e.g.
exertional dyspnoea, paroxysmal nocturnal dyspnoea,
orthopnoea, swelling feet and pain right hypochondrium
(congestive cardiac failure), distention abdomen, discomfort
left hypochondrium with or without jaundice (cirrhosis liver),
periorbital swelling, distention abdomen, and swelling feet
(Nephrotic syndrome).
f) Symptoms suggestive of anxiety or depression (compulsive
water drinking or psychogenic polydipsia).
g) History of attack of palpitation or high fever before polyuria.
PAST HISTORY:
ASK About:
1. Previous head injury or operation on pituitary (Diabetes
insipidus).
2. Treatment for diabetes mellitus
3. Renal colic, pain in lumber region or symptoms of prostatism
(chronic renal failure).
FAMILY HISTORY:
ASK about other relatives suffering from:
1. Diabetes mellitus
2. Renal failure (polycystic kidneys)
DRUG HISTORY:
ASK about the use of diuretics e.g. frusemide, Bumetanide,
spironolactone etc, steroids and any previous treatment for diabetes
mellitus with dose of the drugs used.
DIFFERETIAL DIAGNOSIS:
1. Diabetes mellitus: - this disease can occur in children,
adults or in old age, Usual history is of polyuria,
polydipsia and sometimes polyphagia. Large volumes of
urine are passed on which ants may collect. This causes
dehydration, weakness, weight loss and if untreated
may lead to coma in younger patients. It is often
associated with delayed healing of wounds, pain in the
limbs, generalised itching and loss of sensation which
may cause deep painless ulcer on the feet. These may
be a history of other relatives suffering from Diabetes
mellitus.
2. Diuretic therapy: - often the symptoms of the disease
for which the diuretics are being given, are more
prominent than polyuria due to the diuretics. Such as
patient will have symptoms of congestive cardiac failure
or cirrhosis liver or nephrotic syndrome for which a
diuretic e.g. frusemide, spironolactone, or some
combination diuretic is being used.
3. Chronic renal failure: - Such a patient usually has a past
history of symptoms suggestive of repeated urinary
tract infections. Prostatism or renal colic. Polyuria is not
as troublesome for the patient as are the symptoms of
anorexia, hiccough, nausea, vomiting, diarrhoea,
metallic taste, in the mouth, pallor and breathlessness.
In some cases, e.g. polycystic disease of the kidneys,
there could be a family history of relatives having or
dying of a similar disease.
4. Compulsive water drinking: - In such a patient there are
often symptoms suggestive of anxiety or depression.
Polyuria is the result of excessive intake of water, which
rarely wakes the patient from sleep.
5. Hypercalcemia: - polyuria results from a decreased
concentrating power of the kidneys due to moderate to
severe hypercalcemia. Symptoms include anorexia,
nausea, vomiting, constipation, gritty red eyes and if and
untreated can lead to confusion and coma.
6. Diabetes insipidus: - there is a very sudden onset of
polyuria and polydipsia with patient having a special
craving for ice-cold water. Headache and visual
disturbances may be associated.