• MECHANISM OF ADH

• DEFINITION

• TYPES F DI

• CRANIAL DI

• NEPHROGENIC DI

• CLINICAL FEATURES

• INVESTIGATION

• MANAGEMENT

“Diabetes insipidius is an uncommon disorder which is characterised by the persistent excretion of excessive quantities of dilute urine and by thirst”

Either due to deficiency of ADH or insensitivity to its action

CRANIALDIABETESINSIPIDIUS

NEPHROGE-NIC

DIABETESINSIPIDIUS

DIPSOGENICDIABETES INSIPIDIUS

GESTATIONALDIABETES INSIPIDIUS

FAMILIAL: (vasopressin receptor geneaqua porin-2 gene defect).Idiopathic.Renal tubular acidosis.HypokalemiaHypercalcemiaDrugs (lithium , demeclocycline)

Compensatory polydipisia

Dehydration

NocturiaPolyuria

Samples of blood and urine Dynamic testAssesment of Anterior pituitary function and

supresellar anatomy MRIPlasma electrolytesCalciumInvestigation of renal tract

Treatment of reversible underlying cause (eg. A hypothalamic tumour)

CRANIAL DI • Des-amino-des-aspartate-arginine vasopressin DDAVP

Intranasally (10 – 20 µg once or twice daily

Orally 200µg thrice daily

and IM 2-4µg once daily

NEPHROGENIC DI• THIAZIDE DIURETICS hydrochlorothiazides• CARBAMAZEPINE 200 – 400 mg daily• CHLORPROPAMIDE 200-400 mg daily• NSAIDS (indomethacin 15 mg 8 hourly

Lithium-induced nephrogenic DI may be effectively managed with the administration of amiloride, a potassium-sparing diuretic often used in conjunction with thiazide or loop diuretics.