Diagnostics Procedure

Nocturia Increased urine frequency at night Prostatic hypertrophy Diuretics Early concentrating defect (CKD) Frequency Increased num er of times per day for urination !"I Prostatic Disease

#tep $ (Chec% !rine osmolality&#pecific gra'ity) Osmotic Diuresis ( )** mosm&+ #p, -ra'ity ( $,*$* Water Diuresis !sually . $** mosm&+ #p, gra'ity . $,**)

Polyuria/0ater Diuresis #tep 1/ (Chec% serum sodium) Hyponatremia /Normonatremia Psychogenic Polydipsia

Hypernatremia Dia etes Insipidus

Polyuria (( )+& day) Causes

4ll these patients 5ill e HYPERNATREMIC

#olute Diuresis (2smotic Diuresis)

No further 5or%up is needed Inter'ention is to treat hyperglycemia or alter protein inta%e

:olume Depleted 3ypernatremic

0ater Diuresis

-lucose

!rea

Primary Polydipsia
Primary stimulation of thirst6 7ost pre'alent8 Psychiatric patients Increased an9iety !se of psychotropics 3ypothalamic lesion #arcoid Infiltrati'e disease :ery difficult to o'er5helm the normal urinary free 5ater capacity of $; < 1* + & day E9ample < 1* + &day = >)* cc&hr !sually associated 5ith some concomitant impairment of free 5ater clearance

Dia etes Insipidus

!rine osmolality . $** mosm&+ !rine #pecific -ra'ity . $,**)

Dia etic Ketoacidosis ("ype $ Dia etic)

#e'ere Hyperglycemia ("ype 1 Dia etic)

D9 (Chec% ?esponse to E9ogenous 4D3)

4D3 is gi'en either #A or nasal insufflation ?esponse of the urine osmolality is measured !osm ( ;** mosm&+ Complete Central DI !osm . $** mosm&+ Complete Nephrogenic DI 4nything in et5een is a partial mi9ed disorder

"9
Must a!oi" rapid Na correction due to the ris% of 2D# . $* meq&+ & day #Central Daily E9ogenous 4D3 #Nephro enic 0ater restriction If partial < may gi'e e9ogenous 4D3 N#4IDs "hiaBide diuretics -F? is allo5ed to decrease and the patient 5ill e intentionally 'olume depleted to reduce further losses and reach a steady state

Central (Deficient
secretion of 4D3) Etiology 4utoimmune "rauma Pituitary surgery Ischemic e'ents (C:4/ cere ro'ascular accident) "umor

Nephro enic (?enal resistance to the action of 4D3)

Etiology 3ereditary defects in :1 or aquaporin +ithium 1*@ incidence of NDI Decreased density of :1 receptors Decreased e9pression of aquaporins 4 sor ed through EN4C Pre'ention y using 4miloride 3ypercalcemia & 3ypo%alemia

3igh Protein findings

"u e feedings

4thletes 5ith protein supplements

Inhi it "4+3 Na < C+ a sorption Pre'ents the de'elopment of medullary tonicity Impaired 4D3 signaling of aquaporin generation