CASE REPORT

Dyah Nuriisa Arintadewi

20100310083

1. EXPERIENCE
The 31st years old man came to the hospital with headache, sweating all the times
and felt very thirsty . He said his complains was come suddenly. He could drink 28L/day
and his urination was increase than before. He couldnt remember how many times he
went to the toilet but he said that his morning urine looks darker than the other times.
He decided to go to doctor. After he went to the doctor, the doctor gave him some
medications. Sumnamed, Aspiryna, rutinoscorbin, Calcium Polfa and Lezenie. He drank
the medication for 3 days but he didnt feel better. He said that I felt my body getting
worst. I got fever now than he decided to go to the hospital.
In the hospital, he got many examination. From Anamnesis, Vital Sign, Physical
Examination and his doctor have a plan to doing Fluid Deprivation Examination. During
the doctor did this examination ( around 3-4 days) he didnt get some therapy. In the
middle of his examination he felt worse and the doctor stopped his examination.
The result from Fluid Deprivation didnt show the exactly sign to diagnose the
patient. But the doctors suspect he suffered Diabetic Insipidus.
2. PROBLEM
Why the doctor did Fluid Deprivation examination for this patient?
3. CRITICAL ANALYZE
Fluid Deprivation is medical test which can be used to determine whether the
patient has diabetic Insipidus as opposed to other causes of polydipsia ( a condition of
excessive thirst that causes an excessive intake of water). The patient is required for a
prolonged period, to forgo intake of water completely, to determine the cause of the thirst.
The test measures changes in body weight, urine output and urine composition
when fluids are withheld. Sometimes measuring blood levels of ADH during this test is
also necessary.
If there is no change in the water loss depite fluid deprivation, desmopressin may
be administed to distinguish between the two types of diabetic insipidus which are central
and nephrogenic diabetic insipidus.
The time of deprivation may vary from 4 18 hours. The serum osmolality and
urine osmolality are both measured in the test. So thats why the doctor decided to do this
examination to this patient.

4. DOCUMENTATION

Condition

Urine osmolality in
mOsm/kg, after fluid
deprivation

Afterdesmopressin
or vasopressin

excessive intake of fluid (primary

polydipsia)

> 800

> 800

a defect in ADH production

(central/neurogenic diabetes
insipidus)

< 300

> 800

a defect in the kidneys' response

to ADH production (nephrogenic
diabetes insipidus)

< 300

< 300

5. REFERENCE
http://emedicine.medscape.com/article/117648-workup