Diabetes Insipidus

Diabetes Insipidus
Chronic metabolic disorder characterized by intense thirst and excessive urination

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Diabetes Insipidus or "DI" is a chronic metabolic disorder characterized by intense thirst and excessive urination, caused by a deficiency of the pituitary hormone vasopressin. It is an uncommon condition that occurs when the kidneys are unable to conserve water as they perform their function of filtering blood. The amount of water conserved is controlled by antidiuretic hormone (ADH), also called vasopressin. ADH is a hormone produced in a region of the brain called the hypothalamus. It is then stored and released from the pituitary gland, a small gland at the base of the brain.

This disease is also known as 'water diabetes" and it is always mistaken for diabetes mellitus.  With 4 fundamentally different types of Diabets Insipidus, these four forms must be treated in a different way. The four are as follow:

  1. Nephrogenic - It is caused by insensitivity of the kidneys to the effects of the antidiuretic hormone, vasopressin. It's also called as vasopression-resistant. Visit NDIF for more information.

  2. Neurogenic - Known as central, pituitary, hypothalamic or neurohypophyseal is caused by a deficiency of the antidiuretic hormone, vasopressin. It is caused by damage to the hypothalamus or pituitary gland as a result of surgery, infection, tumor, or head injury. Some medicines, like lithium can also cause it.

  3. Gestagenic -  This is also called as gestational, caused by a deficiency of the antidiuretic hormone, vasopressin, that occurs only during pregnancy.

  4. Dipsogenic - A form of primary polydipsia is caused by abnormal thirst and the excessive intake of water or other liquids.

Symptoms
The major symptoms of diabetes insipidus are excessive urination and extreme thirst. The sensation of thirst stimulates patients to drink large amounts of water to compensate for water lost in the urine.

If thirst mechanisms are normal and adequate fluids are consumed, there are no significant effects on body fluid or salt balance. If inadequate fluids are consumed, the large amount of water lost in the urine may cause dehydration and high sodium levels in the blood.

  • Excessive thirst

    1. May be intense or uncontrollable

    2. May involve a craving for ice water

  • Excessive urine volume

Test
Usually your doctor will check a sample of your urine to see if it is very dilute (weak). He or she will also check a sample of your blood to see if it is concentrated (strong) or diluted. Your doctor may then give you a "water deprivation" test. During the time of this test, you aren't allowed to drink any liquids.

The staff will weigh you, check your urine and draw your blood every hour for several hours. If the results of the test show that you have diabetes insipidus, you will probably also have pictures taken of your brain. You might have a CT (computed tomographic) scan or an MRI (magnetic resonance image). These scans are a little like x-rays. The scans would show if you have a problem in your brain.

  • Urinalysis

  • Blood test

  • Urine output - Central DI urine output suppressed by a dose of ADH

  • CT or MRI of the head

Complication
Inadequate fluid consumption can result in the following complications:

  • Dehydration

    1. Dry skin

    2. Dry mucous membranes

    3. Sunken appearance to eyes

    4. Sunken fontanelles (soft spot) in infants

    5. Fever

    6. Rapid heart rate

    7. Unintentional weight loss

  • Electrolyte imbalance

    1. Fatigue, lethargy

    2. Headache

    3. Irritability

    4. Muscle pains

Treatment
 The cause of the underlying condition should be treated when possible. Central diabetes insipidus may be controlled with vasopressin (desmopressin, DDAVP). Vasopressin is administered as either a nasal spray or tablets. This medicine is very much like your body's natural ADH.

The medicine comes in a nasal spray. You just spray it in each nostril before going to bed. If you have to get up many times in the night, you may need to use the spray at night and in the morning. If you are taking DDAVP, you must make sure you don't drink too much, or your body will get overloaded with fluids. If you get too much fluid in your body, you might feel weak or dizzy, or you might just feel bad all over.

If your diabetes insipidus is caused by kidneys that don't work well with ADH, DDAVP won't help you. Other medicines, like hydrochlorothiazide (a "water" pill), may help. Water pills help your body balance salt and water. Talk to your doctor about which option is right for you

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