Hello everyone,
today we are talking about Diapetes insipidus😀
Diapetes insipidus
is the disease in which large amounts of diluted urine are secreted due to vasopressin hormone deficiency.
Types :
- Central (there is deficiency in the secretion of vasopressin hormone)
- nephrogenic(there is periferal resistance to vasopressin hormone at the level of renal tubules)
- Gestagenic (during pregnancy)
- Dipsogenic( a form of primary polydepsia when there is excess thirst and excess intake of hypotonic fluids which supress ADH secretion)
Cardinal signs of Diapetes insipidus:
- Polydepsia
- polyuria > 5ml/kg/h
- dilute urine
- hypernatremia and dehydration .
Normal serum osmolality is 285:295
2Na +glucose/18+BUN/2.8
Normal urine osmolality is100:1200
2(urine Na+Urine k)
Diagnosis :
clinically
a child with poluria :
If urine osmolality is low so it is water diuresis either DI or primary polydepsia, we differentiate between them by serum osmolality: it is high with DI
if urine osmolality is high so it is solute diuresis like glucosuria or salt losing ...
How to differentiate between central and nephrogenic type:
Desmopressin test
Water deprivation for 8 hours and then measure urine osmolality (it will be low),
then give desmoprssin
if it rises so it is central DI Do MRI brain
if not so it is nephrogenic
if it is primary polydepsia and you did water deprivation for 8h the urine osmolality is high 🤓
Now you can diagnose DI and it’s type
Treatment:
1- central DI : minirin nasal spray .1ml/puff 2 doses per day.
Can use minirn tablets but the spray is better and more efficient
2-Nephrogenic DI: Thiazide or potssiam sparing diuretics, indomethasin.
low solute diet, adequate water intake.
this is it in simple way .
any suggestions in comments 🙏🏻🤗
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