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Urinary Diabetes Insipidus PharmaPedia PharmaGates

Urinary Diabetes Insipidus PharmaPedia PharmaGates

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Published by Islam Fawzy

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Published by: Islam Fawzy on Oct 09, 2012
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this material is free to be used in any educational procedure, downloaded , copied or shared once usedwithout any content modification
Diabetes Insipidus
What is the difference between diabetes insipidus and diabetesmellitus ?
DI should not be confused with diabetes mellitus (DM), DI and DM are unrelated, although they can havesimilar signs and symptoms, like excessive thirst and excessive urination.
Diabetes Mellitus (blood sugar)Diabetes Insipidus
results from insulin deficiency or resistance leading to high blood glucoseOther causes as belowMore common &receives more news coverage Less common ,receives less news coveragehas two main forms, type 1 diabetes and type 2diabetes.a different form of illness altogether.lower urine volume & high concentratedHigher urine volume & less concentrated.
How is fluid in the body normally regulated?
1- For balanced volume and composition of body fluids. Thekidneys remove extra body fluids from the bloodstream.2-These fluids are stored in the bladder as urine. Normally , thekidneys make less urine to conserve fluid when water intake isdecreased or water is lost, for ex:( sweating or diarrhea). Thekidneys also make less urine at night when the body's metabolicprocesses are slower.3-The rate of fluid intake is governed by thirst, and the rate of excretion is governed by the production of 
antidiuretic hormone(ADH)
, also calledvasopressin.4-This hormone is made in the
, asmall gland located in the brain. ADH is stored in thenearby pituitary gland and released into the bloodstreamwhen necessary. When ADH reaches the kidneys, it directsthem to concentrate the urine by reabsorbing some of thefiltered water to the bloodstream and therefore make lessurine.
this material is free to be used in any educational procedure, downloaded , copied or shared once usedwithout any content modification
- DI
occurs when this precise system for regulating the kidneys' handling of fluids is disrupted.
1- frequent urination even at night, which can disrupt sleep and, on occasion, cause bedwetting.2-The large volume of urine is diluted, mostly water .3-To make up for lost water, patient may feel thirst .4-dehydration if they do not drink enough water.5- Children with DI may be irritable or listless and may have fever, vomiting, or diarrhea.
Types of Diabetes Insipidus “D.I.”: (4types)
Central DI(Neurogenic)Nephrogenic DI DipsogenicDIGestational DI
The most common form of serious DI.
It results from damage tothepituitary glandor hypothalamus, whichdisrupts the normalstorage and release of  ADH that caused bydifferent diseases as wellas by ( head injuries,neurosurgery, or geneticdisorders).results when the kidneys areunable to respond to ADH. Thekidneys' ability to respond to ADH
can be impaired :-by drugs-like lithium ,for example.- by chronic disorders includingpolycystic kidney disease,sickle cell disease, kidneyfailure, partial blockage of theureters, chronic renalinsufficiency
and inherited geneticdisorders.-Sometimes the cause of nephrogenic DI is never discovered.by a defect in or damage to thethirstmechanism,which is locatedin thehypothalamus.This defectresults in anabnormalincrease in thirstand fluid intakethat suppresses ADH secretionand increasesurine output.occurs onlyduringpregnancyand resultswhen anenzyme madeby theplacentadestroys ADHin the mother.The placentais the systemof bloodvessels andother tissuethat developswith the fetus.The placentaallowsexchange of nutrients andwasteproducts
this material is free to be used in any educational procedure, downloaded , copied or shared once usedwithout any content modification
betweenmother andfetus.
Because DM is more common and because DM and DI have similar symptoms, a health careprovider may suspect that a patient with DI has DM. But testing should make the diagnosis clear. A doctor must determine which type of DI is involved before proper treatment can begin.Diagnosis is based on a series of tests, including urinalysis and a fluid deprivation test.1-Urinalysis: is the physical and chemical examination of urine.-The urine of a person with DI will be less concentrated( the salt and waste concentrations arelow and the amount of water excreted is high).- A physician evaluates the concentration of urine by measuring how many particles are in akilogram of water or by comparing the weight of the urine with an equal volume of distilled water.2-A fluid deprivation test helps determine whether DI is caused by one of the following:excessive intake of fluida defect in ADH productiona defect in the kidneys' response to ADHThis test measures changes in body weight, urine output, and urine composition when fluids arewithheld. Sometimes measuring blood levels of ADH during this test is also necessary.In some patients, a magnetic resonance imaging (MRI) of the brain may be necessary as well.
 1 25,000, , ,: Familial diabetes insipidus-autosomal dominant disorder.
Milder forms of DI can be managed by drinking enough water, usually between 2 and 2.5 liters a day. DIsevere enough to endanger a person's health is rare.
Central D.I.Nephrogenic D.I.
Desmopressin will not work for this form of DI.
(asynthetic hormone) :
Hydrochlorothiazide (HCTZ):Indomethacin

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