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Diabetes insipidus is characterised by extreme thirst and the passing of vast amounts of urine. It is caused by insufficient vasopressin, a hormone produced by the brain that instructs the kidneys to retain water. Without enough vasopressin, too much water is lost from the body in urine, which prompts the affected person to drink large amounts of fluids in an attempt to maintain their fluid levels. In severe cases, a person may pass up to 30 litres of urine per day. Without treatment, diabetes insipidus can cause dehydration and, eventually, coma due to concentration of salts in the blood, particularly sodium. The name of this condition is a little misleading, since diabetes insipidus has nothing to do with diabetes mellitus (a condition characterised by high blood sugar levels), apart from the symptoms of thirst and passing large volumes of urine. The word diabetes means 'to go through' - describing the excessive urination. Insipidus means the urine is tasteless, whereas mellitus suggests it is sweet from its sugar content. This terminology dates back to a time when physicians literally dipped a finger in the patient's urine and tested its taste. Not a diagnostic method much in use today! SymptomsThe symptoms of diabetes insipidus include:
Too much water is lost in the urineThe kidneys are organs of excretion. They filter the blood to remove wastes (such as urea) and regulate the amount of salts and water in the bloodstream. The hormone vasopressin is made by a structure in the brain called the hypothalamus. Vasopressin controls the amount of water excreted by the kidneys. Diabetes insipidus can be caused by two flaws in this process: the hypothalamus isn't making enough vasopressin or the kidneys aren't responding to the hormone. Either way, the result is the loss of too much water in the urine, leading to the characteristic symptom of excessive thirst. There are various forms of diabetes insipidusThe forms of diabetes insipidus are categorised by cause and include:
Possible complicationsWithout medical treatment, the possible complications of diabetes insipidus include:
Diagnosis methodsDiabetes insipidus is diagnosed using a number of tests including:
Treatment optionsTreatment for diabetes insipidus (DI) depends on the cause. For DI that is associated with decreased vasopressin production, replacement of vasopressin is required. This is usually given by sniffing a small amount of vasopressin that can be absorbed through the lining of the nose. For DI that is associated with reduced or absent response to vasopressin, adequate replacement of fluids is necessary.
Some forms of DI, such as those that occur following head injury or neurosurgery or during pregnancy, resolve with time. Where to get help
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Diabetes insipidus is a condition in which the body loses too much fluid through urination, causing a significant risk of dangerous dehydration and a range of other conditions. Diabetes insipidus, which health experts also call water diabetes, is a rare condition that affects roughly 1 in every 25,000 people in the United States. It develops when the kidneys are unable to prevent the excretion of water, resulting in constant thirst and frequent urination. Usually, a person will produce about 2 quarts (qt) of urine per day. People with diabetes insipidus may produce up to 20 qt of urine daily. While the condition shares a name with diabetes mellitus and may present with similar symptoms, they are unrelated. Diabetes mellitus affects blood sugar, which may cause a person to urinate more often to remove the extra glucose. By contrast, diabetes insipidus affects the kidneys’ ability to properly concentrate urine. Diabetes insipidus usually does not cause serious problems. Typically, people can manage the condition by drinking enough water to stay hydrated. However, this can be more difficult for those who may have trouble addressing their thirst, such as infants or older adults. In these individuals, diabetes insipidus can result in severe complications, such as confusion, seizures, brain damage, or death. The condition takes two main forms: central diabetes insipidus and nephrogenic diabetes insipidus. In the former, the pituitary gland fails to secrete the antidiuretic hormone vasopressin, which regulates bodily fluids. In the latter, vasopressin secretion is not affected, but the kidneys do not respond to the hormone correctly. Diabetes insipidus is not a common condition, and therefore, diagnosis can be challenging and involves ruling out other possible explanations for symptoms. In this article, we discuss diabetes insipidus in detail, including its symptoms, possible causes, and diagnosis. Share on PinterestCavan Images/Getty Images The two main symptoms of diabetes insipidus are the frequent urge to pass high volumes of diluted urine and excessive thirst. These symptoms are also known as polyuria and polydipsia, respectively, and they are two of the three polys of diabetes. Other symptoms of diabetes insipidus can include:
As a result of these symptoms, people may also experience dehydration and disrupted sleep. Without sufficient treatment, diabetes insipidus can also lead to permanent kidney damage. Additionally, infants with diabetes insipidus may have the following symptoms:
Typically, diabetes insipidus occurs due to problems with vasopressin. This hormone is responsible for helping the kidneys balance the amount of fluid and electrolytes in the body. While many cases of diabetes insipidus have no known cause, certain factors may contribute, such as:
Specific causes may vary among the four types of diabetes insipidus, which we describe in the sections below. Central diabetes insipidusCentral diabetes insipidus develops due to a reduction or absence of vasopressin. The condition can be present from birth, which health experts also call primary central diabetes insipidus. A person may acquire secondary central diabetes insipidus later in life. The cause of primary central diabetes insipidus often remains unknown. Some causes result from an abnormality in the gene responsible for vasopressin secretion. The secondary type may occur due to conditions and injuries that affect vasopressin production. These can include brain lesions resulting from head injuries, cancers, or brain surgery. Other systemic, or body-wide, conditions and infections can also trigger central diabetes insipidus. Nephrogenic diabetes insipidusAn individual can inherit or acquire nephrogenic diabetes insipidus. This type affects the response of the kidneys to vasopressin, which can affect water balance to varying degrees. Nephrogenic diabetes insipidus can have numerous causes, including:
Gestational diabetes insipidusIn rare cases, pregnancy can cause a disturbance of vasopressin, especially during the third trimester. This occurs due to the placenta releasing an enzyme that degrades vasopressin. Pregnancy also causes a lower thirst threshold, making a person drink more fluids, while other, typical physiological changes during pregnancy can also affect the kidneys’ response to vasopressin. Gestational diabetes insipidus is treatable during gestation and typically resolves a couple of weeks after childbirth. The condition affects only a few individuals in every 100,000 pregnant people. Dipsogenic diabetes insipidusThis type results from an issue with the hypothalamus, which affects an individual’s sense of thirst, causing them to drink and urinate more often. Causes can include:
The main goal of treatment for all types of diabetes insipidus is to relieve thirst and decrease urine production. Typically, treatment for most types of diabetes insipidus in both adults and children will involve the administration of desmopressin (DDAVP). This medicine is a synthetic version of vasopressin and is available in many different forms, such as tablet, injection, and nasal spray. DDAVP replaces the vasopressin the body is not producing. However, it is important to use the correct dose of DDAVP and only use it when necessary. This is because too much may cause the body to retain too much fluid and develop hyponatremia. As the nephrogenic type occurs due to the kidneys not responding to vasopressin, DDAVP is not a suitable treatment. Instead, a doctor will attempt to treat the underlying cause, which may include switching medications or prescribing a class of diuretics known as thiazides to help reduce the amount of urine the kidneys produce. Additionally, a doctor may recommend:
Due to its prevalence and sharing symptoms with other conditions, diabetes insipidus can be difficult to diagnose. Typically, a doctor will perform a physical examination, view medical history, and ask questions about symptoms. They may also request tests and procedures such as:
In addition to helping determine whether an individual has diabetes insipidus or another condition, these diagnostic tests can also indicate the type and causes of the condition. This in turn can help guide appropriate treatment options and management strategies. Differential diagnosis for diabetes insipidus can include diabetes mellitus, or side effects from current courses of medication, such as diuretics, which may affect water balance. Diabetes insipidus and diabetes mellitus are not related. While the names and some symptoms may be similar, the two conditions have very different causes and treatment options. The words “mellitus” and “insipidus” come from the early days of diagnosing the condition. Doctors would taste the urine to gauge sugar content. If the urine tasted sweet, it meant sugar was present, and diabetes mellitus was a likely diagnosis. However, if the urine was bland or neutral, due to being too diluted, it would indicate diabetes insipidus. The term “insipidus” derives from the word “insipid,” meaning “weak” or “tasteless.” In diabetes mellitus, elevated blood sugar prompts the production of large volumes of urine to help remove the excess sugar from the body. In diabetes insipidus, it is the water balance system that is not functioning effectively. Diabetes mellitus is far more common than diabetes insipidus. However, diabetes insipidus progresses far more rapidly. Of the two conditions, diabetes mellitus can result in more complications and is typically more difficult to manage. Diabetes insipidus is often difficult, if not impossible, to prevent, as it results from either genetic issues or other conditions. However, it is possible to manage symptoms effectively. It is often a lifelong condition, but with ongoing treatment, the outlook can be positive. Diabetes insipidus is a rare condition that affects how the kidneys maintain fluid balance in the body. It causes excessive urine production, which results in frequent urination and persistent thirst. There are many types and causes, but it typically occurs due to problems with vasopressin, which is a hormone that regulates bodily fluids. Diagnosing diabetes insipidus can be difficult and may involve ruling out other conditions with similar symptoms, such as diabetes mellitus. Individuals can usually manage the condition by drinking sufficient amounts of water and taking medications to stay hydrated. Last medically reviewed on March 13, 2022
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