There are two forms of diabetes insipidus (DI):
- Central diabetes insipidus (Central DI)—caused by inadequate antidiuretic hormone (ADH)
- Nephrogenic diabetes insipidus (NDI)—due to renal cells in the kidneys not responding to ADH
ADH controls the amount of water reabsorbed by the kidneys. ADH is made in the
hypothalamus
of the brain. The
pituitary gland, at the base of the brain, stores and releases ADH.
-
Central DI
(up to 50% of cases, the cause is unknown) may be caused by:
- A lack of ADH made in the brain due to a genetic defect
- Damage to the hypothalamus or pituitary glands by surgery, infection, tumor, or head injury
- Sickle cell disease
-
NDI
may be caused by:
Risk Factors
The following factors increase your chance of developing diabetes insipidus:
- Damage to the hypothalamus due to surgery, infection, tumor, or head injury
- Polycystic kidney disease or another kidney disease that may affect the filtration process
- Use of certain medications such as lithium, amphotericin B, or demeclocycline
- High blood levels of calcium
- Low blood levels of potassium
Symptoms
If you have any of these, do not assume it is due to diabetes insipidus. These symptoms may be caused by other health conditions. See your doctor, if you experience any one of them:
- Extreme thirst with preference for cold drinks in central DI
- Muscle weakness
- Headache
- Fever
- Blurred vision
- Low blood pressure
- Rapid pulse
- Frequent urination, especially during the night (nocturia)
- Dehydration
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam may be done.
Tests may include the following:
-
Blood tests
- Electrolytes
- ADH levels
- Blood sugar
-
Urinalysis
- Urine specific gravity and/or osmolality (measures how concentrated or dilute the urine is)
-
Water deprivation test
- Only done under doctor supervision
- Urine output is measured for a 24-hour period
- Diabetes insipidus can cause as much as 4-10 liters of urine to be excreted per day
- Central DI—urine output
is suppressed by a dose of vasopressin/ADH
- NDI—urine output
is not
suppressed by a dose of vasopressin/ADH
- Magnetic resonance imaging (MRI)
of the head—if CDI is suspected
Treatment
Talk with your doctor about the best plan for you. Treatment options include the following:
Central DI
- A synthetic form of ADH—this drug could be taken by mouth, inhaled through the nose, or by injection
- Diuretic “water pill” or an antidiabetic medication—in mild cases to boost the ADH effect on the renal cells in the kidney
NDI
- A diuretic “water pill” could be used
- If lithium is causing the problem—another diuretic, amiloride, could be used
In both CDI and NDI, symptoms can often be reduced by:
- Decreasing the amount of sodium in the diet
- Medication called thiazide diuretics (diuretics they conserve water loss and decrease urine output in people with diabetes insipidus)
Prevention
There are no known ways to prevent diabetes insipidus. It is wise to seek medical attention promptly if you excessive urination and thirst.
Diabetes insipidus. DynaMed website. Available at:
http://www.dynamicmedical.com/dynamed.nsf?opendatabase. Accessed September 20, 2005.
Diabetes insipidus. MedlinePlus Medical Encyclopedia website. Available at:
http://www.nlm.nih.gov/medlineplus/ency/article/000377.htm. Accessed September 18, 2005.
Garofeanu CG, Weir M, Rosas-Arellano MP, et al. Causes of reversible nephrogenic diabetes insipidus: a systematic review.
Am J Kidney Dis. 2005;45:626-37.
Rivkees SA, Dunbar N, Willson TA: The management of central diabetes insipidus in infancy: desmopressin, low renal solue load formula, thazide diuretics.
J Pediatr Endocrinol Metab. 2007;20:459-69.
The Merck Manual of Diagnosis and Therapy. 15th ed. Rahway, NJ: Merck Sharp and Dohme Research Laboratories; 1987.
Majzoub JA, Srivatsa A: Diabetes insipidus: clinical and basic aspects.
Pediatr Endocrinol Rev
2006;Suppl 1: 60-5.
Sands JM, Bichet DG. Nephogenic diabetes insipidus.
Annals Int Med. 2006;144:186-194.
Toumba M, Stanhope R. Morbidity and mortality associated with vasopressin analogue treatment.
Pediatr Endocrinol Metab. 2006;19:197-201.
Last reviewedJuly 2010by
B. Gabriel Smolarz, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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