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CASE HISTORY
33 year old female patient, presented with
history of passing large amount of urine ( about 7 liters / day), for two weeks.
U.Na+
19 25 25 33 25
CASE HISTORY
40 year old Indian male, who complained of headache for 3 months. Investigations revealed craniopharyngioma. Excision done by craniotomy. suprasellar
Urine osmolality 45 mOsmol/ L Serum osmolality 295 mOsmol/ L Serum Na+ 149mmol/ L
DIABETES INSIPIDUS
Definition:
Defined as passage of large
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.