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Emergency Strategy - How to treat diabetes insipidus
Emergency strategy - How to treat diabetes insipidus
Patient will be admitted if presented with altered mental status , trauma to the head, severe dehydration, seizures and imbalance of the electrolytes.
Patient’s airway, breathing, circulation, disability and exposure are assessed and any abnormalities are treated. If the patient suffered from seizures attack, consider treating it. Make sure the patient remain immobilized. IV line is established and considered fluid resuscitation in case the patient suffer from severe dehydration. Blood glucose level is also measured. Traumatic cases should be treated. ( Diabetes insipidus has a strong relation with trauma to the head).
Diabetes insipidus is confirmed by inspecting urine osmolality. Patient who suffer from hypotension is corrected with 0.9% of normal saline. In case of nephrogenic diabetes insipidus patient is treated with restriction of solute, sodium intake, alcohol, beer and excessive drinking which may lead to water intoxication. The patient weight is measured daily and consider medication such as thiazide diuretics which induce natriuresis and NSAIDS. Nephrogenic diabetes insipidus is not responsive to ADH.
Cranial diabetes insipidus is treated with desmopressin ( drug of choice orally or intra nasally) to control symptoms. Desmopressin may lead to cerebral edema post - operatively and it is useful in controlling polyuria and polydipsia. Lysine vasopressin and arginine vasopression may inducee coronary spasm and it is useful for dehydration test. Diabinese ( Chlorpropramide) is useful in partial case of cranial diabetes insipidus as it stimulates the release of AVP and increase the effect of vasopressin at the renal tubules.
After the patient gas been adequately hydrated with normal electrolytes balance and the diagnosis of diabetes insipidus is confirmed, the patient is discharged. Patient will be referred to specialist for further treatment and identification of etiology of diabetes insipidus.
Patient with diabetes insipidus may present with polyuria ( 16 - 24 liters per day of urine being passed), polydipsia ( increase intake of fluid), patient may present with complain of sleep disturbance, growth disturbance, obesity, emotional disturbance, visual disturbance, headache, hyperpyrexia and sexual precocity. Patient may present with trauma to the head, history of drug induced diabetes insipidus, defect of the visual field, seizures, cachexia and dehydration.
The differential diagnosis of diabetes insipidus are psychogenic polydipsia ( due to osmotic diuresis, use of diuretics, diabetes mellitus uncontrolled,solute induced polyuria and acute renal failure), excess of sodium ( hypertonic saline administration, excessive intake of sodium bicarbonate following resuscitation , high sodium in the breast mil, salt poisoning and ingestion of saltwater) and deficit of water ( insensible loss of water, lack of breast feeding and reduce or no intake of water).
The investigations require are full blood count ( to rule out anemia), urea and electrolytes (hypernatremia, hypokalemia, hypercalcemia), urinalysis is performed ( in diabetes insipidus the specific gravity will be low) , serum and urine osmolality (in diabetes insipidus the serum osmolality is high and while urine osmolality is low), imaging technique include MRI of the brain, CT scan of the brain(pituitary gland) and chest x ray. Serum and urine AVP are also performed.
What is diabetes insipidus? Diabetes insipidus is a disorder where a large diluted volume of urine is excreted. Diabetes insipidus commonly present with symptoms of polyuria and polydipsia. There are 2 types of diabetes insipidus. These are nephrogenic diabetes insipidus and cranial diabetes insipidus.
Nephrogenic diabetes insipidus is commonly cause by disorders such as sarcoidosis, sickle cell disease, amyloidosis, congenital renal disorder, polycystic kidney disease, renal dysplasia and obstructive uropathy, hypokalemia and hypercalcemia. Drugs such as demeclocycline, methoxyflurane, phenytoin, aminoglycoside, lithium and amphotericin. All of these condtion may affect the normal function of the kidney. Nephrogenic diabetes insipidus occur due to lack of response to AVP secreted from pituitary gland.
Cranial diabetes insipidus occur due to failure of secretion of AVP hormone. Cranial diabetes insipidus is associated with familial cases /autosomal dominant , non secretion of AVP, increase in AVP threshold level secretion, dysfunctional osmoreceptor and below normal release of AVP. Cranial diabetes insipidus mostly occur as a result of adenoma of the pituitary gland, tumor of the brain, trauma to the head, meningitis, encephalitis, sarcoidosis, craniopharyngioma, Sheehan syndrome ( pregnancy), hypothalamic or pituitary surgery, leukemia, Histiocytosis X and Wolfram syndrome ( deafness, optic atrophy, diabetes mellitus and diabetes insipidus).
Diabetes insipidus may present in pediatric setting. Children may suffer enuresis, infants complaint of high fever, hyperactive, poor feeding, restlessness and irritability as well as growth failure.
References
1.Gl, Robertson. “Diabetes Insipidus.” Endocrinology and Metabolism Clinics of North America 24, no. 3 (September 1995): 549–572.
2.Maghnie, Mohamad, Gianluca Cosi, Eugenio Genovese, Maria Luisa Manca-Bitti, Amnon Cohen, Silvia Zecca, Carmine Tinelli, et al. “Central Diabetes Insipidus in Children and Young Adults.” New England Journal of Medicine 343, no. 14 (2000): 998–1007. doi:10.1056/NEJM200010053431403.
3.Morello, Jean-Pierre, and Daniel G Bichet. “Nephrogenic Diabetes Insipidus.” Annual Review of Physiology 63, no. 1 (2001): 607–630. doi:10.1146/annurev.physiol.63.1.607.
Patient will be admitted if presented with altered mental status , trauma to the head, severe dehydration, seizures and imbalance of the electrolytes.
Patient’s airway, breathing, circulation, disability and exposure are assessed and any abnormalities are treated. If the patient suffered from seizures attack, consider treating it. Make sure the patient remain immobilized. IV line is established and considered fluid resuscitation in case the patient suffer from severe dehydration. Blood glucose level is also measured. Traumatic cases should be treated. ( Diabetes insipidus has a strong relation with trauma to the head).
Diabetes insipidus is confirmed by inspecting urine osmolality. Patient who suffer from hypotension is corrected with 0.9% of normal saline. In case of nephrogenic diabetes insipidus patient is treated with restriction of solute, sodium intake, alcohol, beer and excessive drinking which may lead to water intoxication. The patient weight is measured daily and consider medication such as thiazide diuretics which induce natriuresis and NSAIDS. Nephrogenic diabetes insipidus is not responsive to ADH.
Cranial diabetes insipidus is treated with desmopressin ( drug of choice orally or intra nasally) to control symptoms. Desmopressin may lead to cerebral edema post - operatively and it is useful in controlling polyuria and polydipsia. Lysine vasopressin and arginine vasopression may inducee coronary spasm and it is useful for dehydration test. Diabinese ( Chlorpropramide) is useful in partial case of cranial diabetes insipidus as it stimulates the release of AVP and increase the effect of vasopressin at the renal tubules.
After the patient gas been adequately hydrated with normal electrolytes balance and the diagnosis of diabetes insipidus is confirmed, the patient is discharged. Patient will be referred to specialist for further treatment and identification of etiology of diabetes insipidus.
Patient with diabetes insipidus may present with polyuria ( 16 - 24 liters per day of urine being passed), polydipsia ( increase intake of fluid), patient may present with complain of sleep disturbance, growth disturbance, obesity, emotional disturbance, visual disturbance, headache, hyperpyrexia and sexual precocity. Patient may present with trauma to the head, history of drug induced diabetes insipidus, defect of the visual field, seizures, cachexia and dehydration.
The differential diagnosis of diabetes insipidus are psychogenic polydipsia ( due to osmotic diuresis, use of diuretics, diabetes mellitus uncontrolled,solute induced polyuria and acute renal failure), excess of sodium ( hypertonic saline administration, excessive intake of sodium bicarbonate following resuscitation , high sodium in the breast mil, salt poisoning and ingestion of saltwater) and deficit of water ( insensible loss of water, lack of breast feeding and reduce or no intake of water).
The investigations require are full blood count ( to rule out anemia), urea and electrolytes (hypernatremia, hypokalemia, hypercalcemia), urinalysis is performed ( in diabetes insipidus the specific gravity will be low) , serum and urine osmolality (in diabetes insipidus the serum osmolality is high and while urine osmolality is low), imaging technique include MRI of the brain, CT scan of the brain(pituitary gland) and chest x ray. Serum and urine AVP are also performed.
What is diabetes insipidus? Diabetes insipidus is a disorder where a large diluted volume of urine is excreted. Diabetes insipidus commonly present with symptoms of polyuria and polydipsia. There are 2 types of diabetes insipidus. These are nephrogenic diabetes insipidus and cranial diabetes insipidus.
Nephrogenic diabetes insipidus is commonly cause by disorders such as sarcoidosis, sickle cell disease, amyloidosis, congenital renal disorder, polycystic kidney disease, renal dysplasia and obstructive uropathy, hypokalemia and hypercalcemia. Drugs such as demeclocycline, methoxyflurane, phenytoin, aminoglycoside, lithium and amphotericin. All of these condtion may affect the normal function of the kidney. Nephrogenic diabetes insipidus occur due to lack of response to AVP secreted from pituitary gland.
Cranial diabetes insipidus occur due to failure of secretion of AVP hormone. Cranial diabetes insipidus is associated with familial cases /autosomal dominant , non secretion of AVP, increase in AVP threshold level secretion, dysfunctional osmoreceptor and below normal release of AVP. Cranial diabetes insipidus mostly occur as a result of adenoma of the pituitary gland, tumor of the brain, trauma to the head, meningitis, encephalitis, sarcoidosis, craniopharyngioma, Sheehan syndrome ( pregnancy), hypothalamic or pituitary surgery, leukemia, Histiocytosis X and Wolfram syndrome ( deafness, optic atrophy, diabetes mellitus and diabetes insipidus).
Diabetes insipidus may present in pediatric setting. Children may suffer enuresis, infants complaint of high fever, hyperactive, poor feeding, restlessness and irritability as well as growth failure.
References
1.Gl, Robertson. “Diabetes Insipidus.” Endocrinology and Metabolism Clinics of North America 24, no. 3 (September 1995): 549–572.
2.Maghnie, Mohamad, Gianluca Cosi, Eugenio Genovese, Maria Luisa Manca-Bitti, Amnon Cohen, Silvia Zecca, Carmine Tinelli, et al. “Central Diabetes Insipidus in Children and Young Adults.” New England Journal of Medicine 343, no. 14 (2000): 998–1007. doi:10.1056/NEJM200010053431403.
3.Morello, Jean-Pierre, and Daniel G Bichet. “Nephrogenic Diabetes Insipidus.” Annual Review of Physiology 63, no. 1 (2001): 607–630. doi:10.1146/annurev.physiol.63.1.607.
