Diabetes insipidus: Difference between revisions
No edit summary |
No edit summary |
||
| Line 57: | Line 57: | ||
==Disposition== | ==Disposition== | ||
*Admission for further workup and/or volume replacement | *Admission for further workup and/or volume replacement | ||
*Nephrology f/u | |||
==See Also== | ==See Also== | ||
Revision as of 21:04, 18 February 2016
Background
- Characterized as either central Diabetes Insipidus (DI) or nephrogenic DI [Decreased production of anti-diuretic hormone (ADH) or decreased renal sensitivity to ADH].
- Causes hypernatremia.
Causes
- Central DI
- Cancer
- Pituitary surgery
- Head trauma
- Idiopathic
- Nephrogenic DI
- Renal disease
- Drug Induced (e.g Lithium)
- Hypokalemia
- Hypercalcemia
- Polycystic kidney disease
- Sjogren's
- Amyloidosis
Clinical Features
- Hypernatremia
- Decreased urine osmolality
- Dehydration
- Irritability
- Tremors
- Ataxia
- Hyperreflexia
- Spasms
- Seizures
- death
Differential Diagnosis
Hypernatremia
Water loss:
- Decreased Intake
- Water loss > Na loss
- Central DI
- Head Trauma
- CVA
- Tumor
- Meningitis
- Nephrogenic DI
- Thyrotoxicosis
Sodium gain:
- Increased intake
- Na intake
- NaBicarb
- Incorrect preparation of infant formula
- Renal Na retention (secondary to poor perfusion)
Diagnosis
- Measure serum and urine sodium while patient is water-deprived
- Lack of response to water deprivation is diagnostic.
- Serum Osm >295 mOsm/L
- Record response to 5 units subcutaneous vasopressin.
- Response to vasopressin is diagnostic of central DI (response is indicated by urine osm >800 mOsm/L).
- No response is diagnostic of nephrogenic DI.
Management
- Volume repletion with normal saline or lactated ringers solution
- Patients will be water-deprived.
- Calculate water deficit: [Water deficit (in Liters) = ((Measured sodium/Normal sodium)-1)]
- Serum sodium should not decrease by more than 10-15 mEq/L per day in chronic cases of hypernatremia.
- Over-aggressive reduction of serum sodium may result in cerebral edema secondary to presence of idiogenic osmoles the build up in brain cells when exposed to chronic hypernatremia
- If pt acutely hypernatremic, idiogenic osmoles have not had time to build up in brain tissue and rapid correction of hypernatremia would not develop cerebral edema
- Nephrogenic diabetes insipidus[1]
- Low-salt, low-protein diet
- Hydrochlorothiazide 25mg BID
- Indomethacin has greater effect at reducing urine output than ibuprofen
Disposition
- Admission for further workup and/or volume replacement
- Nephrology f/u
See Also
External Links
References
- ↑ Bichet DG et al. Treatment of nephrogenic diabetes insipidus. UpToDate. Jan 7, 2016. http://www.uptodate.com/contents/treatment-of-nephrogenic-diabetes-insipidus#H10
Tintinalli, Judith. Tintinalli's Emegency MEdicine 7th edition. Pages 120-121