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When you hear the term "diabetes insipidus," you may assume it's related to what'scommonly known as "sugar" diabetes, or diabetes mellitus. While the disorders sharea name and have some common signs, in fact diabetes mellitus (type 1 and type 2)and diabetes insipidus are unrelated. Diabetes insipidus (DI) is a disorder characterized by intense thirst and by theexcretion of large amounts of urine (polyuria). In most cases, it's the result of your body not properly producing, storing or releasing a key hormone, but diabetesinsipidus can also occur when your kidneys are unable to properly respond to thathormone.

Diabetes insipidus is not the disorder of the glucose or sugar regulation, that is diabetes mellitus. Diabetes insipidus is a disorder of body water regulation They have both POLYURIA and POLYDIPSIA

Free water loss Decrease production of ADH by the Hypothalamus Decrease secretion of ADH by posterior pituitary gland Decrease renal response to ADH

Normally, your kidneys remove excess body fluids from your bloodstream. This fluidwaste is stored in your bladder as urine. When your fluid regulation system is working properly, your kidneys make less urine when your body water is decreased, such asthrough perspiration, in order to conserve fluid.The volume and composition of your body fluids remain balanced through acombination of oral intake and excretion in the kidneys. The rate of fluid intake islargely governed by thirst, although your habits can increase your intake far above theamount necessary. The rate of fluid excreted by your kidneys is greatly influenced bythe production of anti-diuretic hormone (ADH), also called vasopressin

Your body makes ADH in the hypothalamus and stores the hormone in your pituitarygland, a small gland located in the base of your brain. ADH is released into your bloodstream when necessary. ADH then concentrates the urine by triggering thekidney tubules to reabsorb water back into your bloodstream rather than excretingwater into your urine. Diabetes insipidus occurs when this system is disrupted and your body can't regulatehow it handles fluids. The way in which your system is disrupted determines whichform of diabetes insipidus you have

Polydispsia Polyuria Hypernatremia Hyperosmolar (increase osmolarity of blood>295mOsm/kg Tachycardia

Neurogenic Nephrogenic

Central DI Caused by any organic lesion that interfere witch ADH synthesis,transport or release - stroke - tumors - injury

Replace free water with hypotonic solution to equal urinary losses - PNSS - hormonal repalcement with desmopressin acetare an analogue of ADH - orally - intravenously - nasal spray - chlorpropramide(diabenese) helps the ADH that is circulating to work better and stimulates endogenous release of ADH

Condition where adequate ADH levels are present but kidney fail to respons appropriately Lithium is common cause of NDI - blocks the effect of ADH on the kidneys renal tubules

If oral intake cannot keep up with urinary loss Severe fluid vol. deficit Weight loss Constipation Poor skin turgor Hypotension Tachycardia Shock

Water deprivation test. This test helps determine the cause of diabetesinsipidus. You'll be asked to stop drinking fluids two to three hours before thetest so that your doctor can measure changes in your body weight, urine outputand urine composition when fluids are withheld. In some cases your doctor may also measure blood levels of ADH during this test. Urinalysis is the physical and chemical examination of urine. If your urine is less concentrated (meaning the amount of water excreted is highand the salt and waste concentrations are low)

Magnetic resonance imaging (MRI) scan.An MRI of the head is anoninvasive procedure that uses powerful magnets and radio waves toconstruct detailed pictures of brain tissues. Your doctor may want to performan MRI to look for abnormalities in or near the pituitary gland.

Low sodium diet No more than 3 per day may helps decrease urine out put Thiazide diuretics Hydrochlorothiazide(HCTZ) Chlorothiazide(DIURIL) These medication slow kidney filtration rate allowing for more absorption of free water.

Iv fluid replacement Oral fluid replacement i&o Daily weight

Urine specific gravity (1.005-1.030) urine specific gravity<1.005 Serum osmolality(285-295 mOsm/kg) Serum osmolality >295

DI

Neurogenic cause

Nephrogenic cause

Decrease ADH secretion Kidney tubules fail to reabsorb Plasma hyperosmolality

Increase urination of dilute urine nocturia, decreasing urine specific gravity dehydration

Stimulate thirst center

polydipsia