Diabetes Insipidus

& SIADH
 Diagnostic Approach to
Diabetes Insipidus

Obtain
BMP

↑Na

Obtain
Urine and Serum Osmolality
Primary Polydipsia
↑Serum Osmolality
↓Urine Osmolality
↑Urine Osmolality

Perform
Water Deprivation test

No change in urine osmolality

Perform
DDAVP test
No change
↑Urine Osmolality
in Urine Osmolality

Central DI Nephrogenic DI
 Diagnostic Approach to
SIADH

Obtain
BMP

↓Na

Obtain
Urine and Serum Osmolality

↓ Serum Osmolality
↑ Urine Osmolality

Obtain
Volume Status

Euvolemic

Obtain
TFTs and Cortisol
to rule out causes of Euvolemic Hyponatremia

Normal TFTs and Cortisol

SIADH
 Treatment of
Diabetes Insipidus

Type Purpose of Treatment Treatment

Central DI Replace ADH - Desmopressin (DDAVP)

Nephrogenic DI Induce Mild Hypovolemia - Sodium restriction and Thiazide diuretics

 Treatment of
SIADH

H20 Restriction
Type Purpose of Treatment Treatment Vaptans

- Water Restriction
Chronic Asymptomatic
- Salt Tablets
Hyponatremia
- Vaptans or Loop Diuretics
SIADH
Acute Symptomatic
- 3% Hypertonic saline
Hyponatremia

Hyponatremia Due to SIADH

Loop
Diuretics
Chronic and/or Asymptomatic? Acute and/or symptomatic and or Na <120?

Start free water restriction Initiate 3% HTS H20 Loss

From Nephron

Refractory

Dont exceed >6-8meq/L in 24 hours

Initiate
Salt Tablets and Loop diuretics

Refractory ↓ Risk of
Osmotic Demyelination Syndrome
Initiate Vaptans (ODS)