Clinical approach-polyuria

polyuria

>3L/dDifferentiate fm inc frequencyCollect 24hr urine

causes

• PhysiologicalExcessive intake of fluidCold climateAnxietyPro rich diet

• PathologicalEndocrineRenalSystemicPsychiatricDrugsIatrogenic

1. Endocrine- DM, Central DI, Hyperparathyroidism, cushing’s & conn’s syndrome

2. Renal-CRF(early),ATN(diuretic phase), pyelonephritis,nephrogenic DI

3. Systemic- amyloidosis,sickle cell anemia

5. Drugs- diuretics,Li,anticholinergics

6. Iatrogenic-excessive IVF, mannitol infusion,radiocontrast media

4. Psychiatric-schizophrenia

>3L/d<250 mosmol solutes/d

Water diuresis Polydipsia DIWATER DEPRIVATION TEST ,

ADH SENSITIVITY

>300mosmol solutes/d

Solute/osmotic diuresis Glucose[DM] Mannitol Urea[pro] Na+[diuretics] Ca2+[hyperparathyroid]

History

1.Gen data2.PC- polyuria3.HOPC-# ass with fatigue,wt loss » DM# ass with depression »

prim.Hyperparathy.# ass with bone pain » multiple

myeloma# oliguria first » ATN

4.Past History-#h/o transurethral resection of

prostate » post obstructive diuresis

#h/o neurosurgery » central DI

5.Personal History-Diet-proteinAppetite-DMAddiction-caffeine

6.Family History- DM, PKD, Sickle cell anemia

7.Treatment History- diuretics,Li, anticholinergics

8.Allergic History9.SES10.Menstrual history

Gen examination

Poorly built & nourished- DM Coma- natriuresis Not oriented- schizophrenia Pallor- sickle cell anemia, CRF Edema- RF

Pulse high vol- DM, Sickle cell

anemia, pyelonephritis low vol- electrolyte imbalance BP high-DM, PKD, Conn’s low- DI

Febrile- pyelonephritis

Tachypnoea- DM,Bartter’s syndrome

GIT examination

inspection- dry oral cavity- sjogren’s syndrome, anticholinergics

palpation- pain- pyelonephritis;

mass- PKD

Percussion- dull note- PKD

Auscultation- bruits- RF

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