Diabetes Insipidus (Agu Presentation)
Transcript of Diabetes Insipidus (Agu Presentation)
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DIABETES INSIPIDUS
DR. JALILA AL AALI
CONSULTANT ENDOCRINOLOGIST
SALMANIYA MEDICAL COMPLEX
February 28th 2006
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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.
Urine osmolality 110 mOsmol/ L
Serum osmolality 289 mOsmol/ L
Serum Na+ 149mmol/ L
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WATER DEPRIVATION TEST
TIME S.osmo S.Na+
U.osmo U.Na+
Basal 289 141 35
2H 296 146 70 19
4H 297 147 105 256H 289 147 105 25
8H 304 150 175 33
POST VASOPRESSIN1H 293 142 - -
4H - - 140 25
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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
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CASE HISTORY
■ 40 year old Indian male, who complained
of headache for 3 months.
■ Investigations revealed suprasellar
craniopharyngioma.
■ Excision done by craniotomy.
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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
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WATER DEPRIVATION TEST
TIME S.osmo S.Na+
U.osmo
Basal 295 149 45
2H 296 149 70
4H 297 150 95 6H 299 152 101
8H 309 153 125
POST VASOPRESSIN1H 293 142 435
4H 287 141 729
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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
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DIABETES INSIPIDUS
Definition:
Defined as passage of large
volumes (more than 3 litre/24 hrs)
of dilute urine (osmolality less than
300 mOsmol/kg).
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Classification:
① Cranial: due to deficiency of circulating
ADH.
Causes: Trauma
Tumors
Idiopathic
Inflammatory conditions
Infections
Familial (AD)
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② Nephrogenic : due to renal resistance to
ADH.
Causes : Familial (X-linked recessive).
Drugs (lithium, demeclocycline).Metabolic (hypercalcemia,
hypokalemia).
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③ Primary polydipsia:
Psychological excessive water drinking
Suppression of ADH
Polyuria
Increase excretion of solutes
Reduce urine concentrating capacity
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DIAGNOSIS
► Large amount of diluted urine ( more than3 liters/day, and osmolality less than 300mOsmol/kg).
► Hypernatremia ( Na+ ).
► Increase serum osmolality ( more than 295mOsmol/kg ).
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Water deprivation test
No change in urine volume & osmolality
Diabetes Insipidus Give 2 µg IM desmopressin
DIAGNOSIS
Urine osmolality No change inUrine osmolality
Central D.I Nephrogenic D.I
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Treatment
► Central : Vasopressin analogue ( Desmopressin )
intranasally or parentrally ( SC, IV, IM).
► Nephrogenic:
Thiazide diuretics.