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DIABETES INSIPIDUS

DR. JALILA AL AALI


CONSULTANT ENDOCRINOLOGIST

SALMANIYA MEDICAL COMPLEX

February 28th 2006

CASE HISTORY
33 year old female patient, presented with

history of passing large amount of urine ( about 7 liters / day), for two weeks.

Urine osmolality 110 mOsmol/ L

Serum osmolality 289 mOsmol/ L


Serum Na+ 149mmol/ L

WATER DEPRIVATION TEST


TIME S.osmo S.Na+ Basal 289 141 2H 296 146 4H 297 147 6H 289 147 8H 304 150 POST VASOPRESSIN 1H 293 142 4H U.osmo 35 70 105 105 175
140

U.Na+
19 25 25 33 25

WATER DEPRIVATION TEST


Interpretation: Low urine osmolality at baseline. After 8 hours, serum osmolality increased, but urine osmolality remain low. Diabetes Insipidus Vasopressin No change in urine omolality Nephrogenic Diabetes Insipidus

CASE HISTORY
40 year old Indian male, who complained of headache for 3 months. Investigations revealed craniopharyngioma. Excision done by craniotomy. suprasellar

CASE HISTORY (cont.)


One day postoperatively, he started to pass large amount of urine ( 6 liters / day ).

Urine osmolality 45 mOsmol/ L Serum osmolality 295 mOsmol/ L Serum Na+ 149mmol/ L

WATER DEPRIVATION TEST


TIME S.osmo S.Na+ Basal 295 149 2H 296 149 4H 297 150 6H 299 152 8H 309 153 POST VASOPRESSIN 1H 293 142 4H 287 141 U.osmo 45 70 95 101 125
435 729

WATER DEPRIVATION TEST


Interpretation: Low urine osmolality at baseline. After 8 hours, serum osmolality increased, but urine osmolality remain low. Diabetes Insipidus Vasopressin Increase in urine omolality Central Diabetes Insipidus

DIABETES INSIPIDUS
Definition:
Defined as passage of large

volumes (more than 3 litre/24 hrs)


of dilute urine (osmolality less than 300 mOsmol/kg).

Classification: Cranial: due to deficiency of circulating ADH. Causes: Trauma Tumors Idiopathic Inflammatory conditions Infections Familial (AD)

Nephrogenic : due to renal resistance to ADH. Causes : Familial (X-linked recessive). Drugs (lithium, demeclocycline). Metabolic (hypercalcemia, hypokalemia).

Primary polydipsia:
Psychological excessive water drinking Suppression of ADH Polyuria Increase excretion of solutes Reduce urine concentrating capacity

DIAGNOSIS

Large amount of diluted urine ( more than 3 liters/day, and osmolality less than 300 mOsmol/kg).

Hypernatremia ( Na+ ).
Increase serum osmolality ( more than 295 mOsmol/kg ).

DIAGNOSIS
Water deprivation test No change in urine volume & osmolality Diabetes Insipidus Give 2 g IM desmopressin
Urine osmolality No change in Urine osmolality Nephrogenic D.I

Central D.I

Treatment

Central : Vasopressin analogue ( Desmopressin ) intranasally or parentrally ( SC, IV, IM). Nephrogenic: Thiazide diuretics.

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