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Diabetes Insipidus

Overview

A disorder characterized by pronounced thirst and the passage of large quantities of dilute urine, caused by a defect of thekidney tubules.


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Causes

Antidiuretic hormone (ADH; vasopressin) is a hormone produced in the hypothalamus of the brain. It concentrates the urine bytriggering the kidneys to reabsorb water into the blood stream rather than excreting water into the urine.Nephrogenic diabetes insipidus involves a defect in the kidney tubules (the portion of the kidneys that causes water to beexcreted or reabsorbed). The kidney tubules lack the receptor for ADH that transmits the instruction to concentrate the urine tothe inside of the cells. Excessive amounts of water are excreted with the urine, producing a large quantity of very dilute urine.There is no response to vasopressin, even though the blood level of this hormone is higher than normal.If thirst mechanisms are normal and adequate fluids are consumed, there are no significant effects on the fluid and/or electrolytebalance of the body. If inadequate fluids are consumed, the high urine output may cause dehydration and high blood sodium.Nephrogenic dI is a very rare disorder, affecting about 5 out of 100,000 people. It occurs primarily as a congenital, sex-linkeddisorder (congenital nephrogenic dI) that usually affects men, although women can pass the gene on to their children.Nephrogenic diabetes insipidus may also be acquired (developed as a result of another disorder) in some people, especially thosewho have disorders of the renal medulla (such as amyloidosis) , myeloma, malnutrition, analgesic nephropathy, decreased serumpotassium levels, increased serum calcium levels, sickle cell anemia, and in women who are or who have recently been pregnant.It may be acquired by people who are taking medications including demeclocycline, lithium, and methicillin.The primary risk factors include family history of congenital DI, and/or a history of medications or disorders associated withacquired nephrogenic dI.


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Signs & Symptoms

excessive thirst- may be intense or uncontrollable- craving for ice water may be present- excessive urine volume- may exceed 3 to 15 liters per dayInadequate fluid consumption can result in:- dehydration- dry skin- dry mucous membranes- sunken appearance to eyes- sunken fontanelles (soft spot) in infants- fatigue, lethargy- headache- irritability- low body temperature- muscle pains- rapid heart rate- weight loss

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Prevention

There is no known prevention for congenital nephrogenic diabetes insipidus . Treatment of causative disorders may preventsome cases of acquired nephrogenic dI . Medications should only be used under the supervision of the health care provider.


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Treatments
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