• 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.
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