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Water Deprivation Test

Water Deprivation Test

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Published by sanham

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Published by: sanham on Aug 14, 2008
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CC SOP0034
Dynamic Function test
Water Deprivation TestStandard Operating ProcedureCC0034
Version: 1Review date: 14/08/2009Author:Swati BhatDocument Manager:Robin SanhamAuthorised by:Richard Mainwaring-BurtonVersion date: 14/08/2008
THIS DOCUMENT IS THE PROPERTY OF THE DEPARTMENT OF CLINICALCHEMISTRYTHIS DOCUMENT, OR ANY PART THERE OF, MUST NOT BE REPRODUCED WITHOUTTHE PERMISSION OF THE HEAD BMS OF CLINICAL CHEMISTRYRelated Documents
Hazard data sheetsRisk assessmentsOthers
WATER DEPRIVATION TESTSTANDARD OPERATING PROCEDURECC0034
Do not photocopy this document
Page
 
1 of 7Last printed: 14 August 2008
 
CC SOP0034
Dynamic Function test
Water Deprivation TestStandard Operating ProcedureCC0034
Version: 1Review date: 14/08/2009Author:Swati BhatDocument Manager:Robin SanhamAuthorised by:Richard Mainwaring-BurtonVersion date: 14/08/2008
Water Deprivation TestThis test is potentially very dangerous and must be undertaken with great care.Patients unable to conserve water may become critically dehydrated withina few hours of water restriction.
This test is performed when there is a strong suspicion of cranial or nephrogenic diabetes insipidusand primary polydipsia.Other causes of polydipsia & polyuria eg diabetes mellitus, hypoadrenalism, hypercalcaemia,hypokalaemia, hypothyroidism, urinary infections, chronic renal failure and therapy withcarbamazepine, chlorpropamide or lithium therapy must be excluded prior to performing this test.Similarly if there is evidence for the ability to concentrate urine eg spot urine osmolality > 750mOsm/kg this test must not be performed.
Principle
Water restriction in the normal individual results in secretion of AVP by the posterior pituitary in order to reclaim water from the distal renal tubules. Failure of this mechanism results in a rise in plasmaosmolality due to water loss, and a dilute urine of low osmolality. The two causes are:a) a failure of AVP secretionb) insensitivity of the renal tubules to AVPThe two may be distinguished by the administration of DDAVP (synthetic AVP).
Side effects
Patients with true Diabetes insipidus may become severely water depleted during water deprivationand MUST be carefully monitored throughout the procedure.
Preparation
Subjects should not smoke during the day of the test and should avoid alcohol and caffeine containingdrinks on the previous evening as all these influence the action of AVP.
Do not photocopy this document
Page
 
2 of 7Last printed: 14 August 2008
 
CC SOP0034
Dynamic Function test
Water Deprivation TestStandard Operating ProcedureCC0034
Version: 1Review date: 14/08/2009Author:Swati BhatDocument Manager:Robin SanhamAuthorised by:Richard Mainwaring-BurtonVersion date: 14/08/2008
Test Procedure
DO NOT RESTRICT FLUIDS UNTIL THE TEST COMMENCES0 hr Weigh subjectBegin fluid balance chartTake samples of urine and plasma for osmolality and electrolyte levelsCommence fluid restriction1 hr and hourlythereafter Weigh subjectMeasure urine volumeTake samples of urine and plasma for osmolality and electrolyte levels
Modified Water Deprivation Test
If DI is not strongly suspected or if the above test procedure is uninterpretable because it was notcontinued for long enough, or if there is already evidence that the kidneys have some concentratingability eg random urine osmolality > plasma, then it is safe to perform the modified water deprivationtest.
Procedure
RESTRICT FOOD AND DRINK AFTER MIDNIGHT PRIOR TO TEST.00:00 hr Weigh subjectTake samples of urine and plasma for osmolality and electrolyte levelsCommence fluid restriction08:00 hr and hourlythereafter Weigh subjectMeasure urine volume take samples of urine and plasma for osmolality andelectrolyte levelsFor both the above procedures fluid restriction should be
stopped
if:
there is a fall in weight > 5%
plasma osmolality > 300mOsm/kgThe test should be terminated if urine osmolality rises > 750 mOsm/kg.When urine osmolality rises < 30 mOsm/kg (in toto) over 3 successive urine samples proceed toDDAVP test as below only if the patient does not suffer with heart failure or ischaemic heart disease:
Procedure
Administer DDAVP 2 microgram i.m.Measure urine volume and osmolality at hourly intervals for at least 3 hoursRestrict fluid to less than 500 mL in the 8 hours after the test
Do not photocopy this document
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3 of 7Last printed: 14 August 2008

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