Diabetes Insipidus

• Diabetes insipidus (DI) is characterized by the decreased ability of the

kidneys to concentrate urine.
• Antidiuretic hormone (ADH) is the primary determinant of free water
balance
• ADH is produced in posterior pituitary and acts on the V2 receptors of
the collecting tubules of the kidney
• ADH alters the permeability of the collecting tubes to control the free
water excretion

• Rare disease with prevalence of 3 per 100,000 population

• No significant sex gender difference
DI can be due to different distinct mechanisms (Figure 117-1).
 Differential Diagnosis

• Diabetes mellitus
• Cushing syndrome
• Lithium
• Psychogenic polydipsia
 Diagnosis (Figure 117-2)

• No single diagnostic laboratory test

• 24-hour urine output of less than 2 liters rules out DI
• Hyperuricemia can be seen as urate clearance is reduced due to reduced V1
stimulation
• MRI of the pituitary and hypothalamus should be done to rule out mass lesions
– In T1-weighted MRI, the normally present bright spot in the sella is lost in most DI
patients
• Water deprivation test is the gold standard for diagnosing DI (see Figure 117-2)
– Check baseline Na+; do not permit oral intake, measure volume and osmolality of each
voided urine sample; weigh patient
– When two consecutive urine osmolality do not vary by more than 10% and the patient
has lost 2% of weight, check Na+, urine osmolality and serum vasopressin levels. Then
give 2 mg of desmopressin if needed
FIGURE 117-2. DIAGNOSIS OF DIABETES INSIPIDUS
 Treatment

• Goal: to prevent nocturnal enuresis and to

control polydipsia
• General: Avoid dehydration by drinking fluids
to match the urine output and by providing
intravenous fluid replacement with hypo-
osmolar fluid
TREATMENT
• Source
• Chapter 117. Diabetes Insipidus
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