Encyclopedia

Diabetes insipidus

Description

Diabetes insipidus is a rare disease characterized by the feeling of intense thirst despite drinking large amounts of fluids /polypsidia/, as well as the excretion of large amounts / polyuria/.

In most cases, it is the result of improper secretion, storage and release of antidiuretic hormone /ADH/, but it can also develop when the kidneys are not able to respond properly to it.

Rarely, diabetes insipidus can develop during pregnancy – gestational diabetes mellitus.

What are the symptoms?

• Constant strong thirst;
• Excreting an excessive amount of dilute urine;

Depending on the severity of the disease, urine output can vary from 2 liters per day in milder forms to 20 liters in the most severe cases and if large amounts of fluids are taken.

For comparison, the average amount of diuresis also varies in healthy adults, but is in the range of 1.5-2.5 liters per day.

Other signs of the condition are frequent waking up at night due to the urge to urinate /nocturia/ and nocturnal enuresis /nocturnal urination/.

Infants and young children who have diabetes insipidus may exhibit the following clinical manifestations:
• Unexplained irritability or inconsolable crying;
• Excessively wet diapers;
• Fever, vomiting, or diarrhea;
• Dryness with cool extremities;
• Slowed growth rates of height and weight gain;
• Weight loss;

When should you seek medical attention?

See your doctor immediately if you or your child exhibit the two most common symptoms of the disease: constant thirst and excessive amounts of urine.

What are the causes?

Disease occurs when the body is unable to regulate its fluid levels. Normally, the kidneys remove excess fluids from the blood. These expelled fluidsare temporarily stored in the bladder as urine before a person urinates.

When this “fluid regulation system of sorts” is functioning normally, the kidneys produce less urine when the body’s fluid level has decreased, such as during profuse sweating, thereby conserving some body water.

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The volume and composition of body fluids remains balanced through a combination of oral water intake and renal excretion.

The amount of fluid intake is largely controlled by thirst, although with the formation of certain habits this amount can increase significantly beyond what is needed.

The volume of fluid excreted by the kidneys is strongly influenced by the secretion of the antidiuretic hormone, also called vasopressin.

The human body synthesizes ADH in the hypothalamus and stores the hormone in the pituitary gland. ADH is released when the body begins to become dehydrated. Vasopressin then concentrates in the urine by stimulating the renal tubules to release water back into the blood rather than excreting it in the urine.

Treatment of diabetes insipidus

Treatment is determined by the form of the disease:

Central diabetes insipidus – since the cause of this form of the disease is ADH deficiency, treatment usually consists of taking a synthetic hormone called desmopressin.

The hormone can be taken as a nasal spray, oral tablets or by injection. The synthetic hormone will normalize the amount of diuresis.

Nephrogenic diabetes insipidus – results from the kidneys not responding properly to ADH and therefore desmopressin is not effective.

Instead, your doctor will prescribe a salt-free diet, which will help reduce the amount of urine produced by the kidneys.

The drug hydrochlorothiazide, used alone or with other drugs, can relieve the symptoms of the disease.

The gestational form is also treated with desmopressin.

Primary polypsidia – the main treatment is to reduce fluid intake.

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