The patients of diabetes insipidus present to the hospital with the complaint of polyuria and/or dehydration. The patient may pass 5 to 20 or even more liters of urine in 24 hours. The urine has a very low specific gravity and osmolality.

As the patient loses a lot of water, signs of dehydration start appearing. The mouth becomes dry and the skin loses its elasticity. The patient also has excessive thirst (polydipsia).

• Fatigue

  […] temperature (hyperthermia) unexplained weight loss In older children, symptoms of diabetes insipidus include: wetting the bed (enuresis) – although most children who wet the bed do not have diabetes insipidus loss of appetite feeling tired all the time (fatigue [nhs.uk]

  […] symptoms  Polyuria with urine output of 5 to 15 L daily  Polydipsia, especially a desire for cold fluids  Marked dehydration, as evidenced by dry mucous membranes, dry skin, and weight loss  Anorexia and epigastric fullness  Nocturia and related fatigue [slideshare.net]

  Symptoms may include: Dry mucous membranes Dry skin Sunken appearance to eyes Sunken fontanelles (soft spot) in infants Changes in memory or balance Other symptoms that can occur due to lack of fluids, causing dehydration, include: Fatigue, feeling weak [nlm.nih.gov]

  Symptoms of dehydration include: Dry skin Dry mucous membranes (sticky mouth) /reduced tears Sunken appearance to eyes Sunken fontanelles (soft spot in the skull) in infants Fatigue/sleepiness Weight loss Headache Irritability Low body temperature Muscle [histio.org]

• Weight Loss

  Sympathomimetic amine therapy very effectively controlled the weight gain and methimazole controlled the weight loss. [ncbi.nlm.nih.gov]

  The symptoms characteristic of CDI are polyuria and polydipsia, usually associated with weight loss. Nocturia is common and in children often presents as enuresis. [orpha.net]

  Signs and symptoms that could suggest diabetes insipidus include: excessive crying irritability slower than expected growth high body temperature (hyperthermia) unexplained weight loss In older children, symptoms of diabetes insipidus include: wetting [nhs.uk]

• Enuresis

  […] symptoms that could suggest diabetes insipidus include: excessive crying irritability slower than expected growth high body temperature (hyperthermia) unexplained weight loss In older children, symptoms of diabetes insipidus include: wetting the bed (enuresis [nhs.uk]

  Symptoms: polyuria and polydipsia, enuresis, FTT/poor growth, unexplained fevers, constipation Diagnosis: elevated serum Na in patients with abnormal thirst mechanism and dilute urine (as above) vs failure to concentrate urine after a water deprivation [utmb.edu]

  Mild cases may present with unremitting enuresis (bed-wetting). Risk Factors Brain tumor or pituitary gland tumor. Head Injury Infections such as meningitis, encephalitis, tuberculosis. Sarcoidosis Family history of diabetes insipidus. [rxmed.com]

  Nocturia is common and in children often presents as enuresis. Polyuria is characterized by a urine volume in excess of 150 ml/kg/24h at birth, 100-110 ml/kg/24h until the age of 2 years, and 40-50 ml/kg/24h in older children and adults. [orpha.net]

• Nocturnal Awakening

  Zoom Clinical diagnosis Clinical work-up should assess the onset and duration of the symptoms, nocturnal awakening, medication used and the familial background to address the possible hereditary nature of the disorder. [em-consulte.com]

• Large Pericardial Effusion

  Transthoracic heart ultrasound revealed large pericardial effusion and a heterogeneous mass that compressed the right ventricle. No osteosclerotic lesions on appendicular bones were present. [ncbi.nlm.nih.gov]

• Polydipsia

  The final diagnosis was primary polydipsia in 82 patients (57%), central diabetes insipidus in 59 (41%), and nephrogenic diabetes insipidus in 3 (2%). [doi.org]

  The water deprivation test with assessment of AVP activity is currently the gold standard for differential diagnosis in patients presenting polyuria-polydipsia syndrome. [ncbi.nlm.nih.gov]

  Primary polydipsia Primary polydipsia is characterised by an individual consuming large volumes of fluid and as a result producing large volumes of dilute urine. [geekymedics.com]

• Constipation

  Consume plenty of high-fiber foods and fruit juices to prevent or treat constipation. When to Call a Doctor See a doctor immediately if you develop symptoms of diabetes insipidus. [healthcommunities.com]

  Disease definition Nephrogenic diabetes insipidus (NDI) is characterized by polyuria with polydipsia, recurrent bouts of fever, constipation, and acute hypernatremic dehydration after birth that may cause neurological sequelae. [orpha.net]

  Symptoms: polyuria and polydipsia, enuresis, FTT/poor growth, unexplained fevers, constipation Diagnosis: elevated serum Na in patients with abnormal thirst mechanism and dilute urine (as above) vs failure to concentrate urine after a water deprivation [utmb.edu]

  Constipation. Mild cases may present with unremitting enuresis (bed-wetting). Risk Factors Brain tumor or pituitary gland tumor. Head Injury Infections such as meningitis, encephalitis, tuberculosis. Sarcoidosis Family history of diabetes insipidus. [rxmed.com]

  An infant or young child with diabetes insipidus may have the following signs and symptoms: Heavy, wet diapers Bed-wetting Trouble sleeping Fever Vomiting Constipation Delayed growth Weight loss When to see a doctor See your doctor immediately if you [mayoclinic.org]

• Loss of Appetite

  […] the bed (enuresis) – although most children who wet the bed do not have diabetes insipidus loss of appetite feeling tired all the time (fatigue) Page last reviewed: 2 April 2019 Next review due: 2 April 2022 [nhs.uk]

  Symptoms of an electrolyte imbalance may include: Weakness Nausea Vomiting Loss of appetite Muscle cramps Confusion Feb. 16, 2019 [mayoclinic.org]

  Feeling very thirsty and drinking more liquid than usual Losing weight without trying Dry skin Feeling confused, weak, and dizzy Fatigue Headaches and vision changes Children may have irritability, a loss of appetite, and slow growth How is diabetes insipidus [drugs.com]

• Hypotension

  We report vasopressin (AVP) responses to hypotension in nine patients with ADI and nine controls. [ncbi.nlm.nih.gov]

• Facial Pain

  A 69-year-old woman suffering from exophthalmos and facial pain came to us referred for aetiological diagnosis of exophthalmos. [ncbi.nlm.nih.gov]

• Confusion

  Dipsogenic diabetes insipidus is a syndrome of disordered thirst, in patients without psychiatric disease, which may be confused with partial central diabetes insipidus. Distinguishing these entities involves monitored water testing. [ncbi.nlm.nih.gov]

  If you experience the signs of dehydration, such as confusion, dizziness or sluggishness, seek immediate care. [draxe.com]

  DI is easily confused with an entirely unrelated disorder, psychogenic polydipsia. Polydipsia refers to drinking large amounts of water. [medical-dictionary.thefreedictionary.com]

  They include: Thirst Fatigue Dry skin Nausea Sluggishness Dizziness Confusion Sluggishness, dizziness, and confusion can be signs of severe dehydration, which requires immediate medical care. [verywellhealth.com]

  You feel confused. You have a seizure. Care Agreement You have the right to help plan your care. Learn about your health condition and how it may be treated. [drugs.com]

• Headache

  She consulted due to a headache with warning signs associated with altered visual acuity. Brain MRI was performed which showed signs of a non-adenomatous lesion with suprasellar and hypothalamic extension. [ncbi.nlm.nih.gov]

  This can result in: headaches dizziness feeling bloated hyponatraemia – a low level of sodium (salt) in your blood Symptoms of hyponatraemia include: a severe or prolonged headache confusion nausea and vomiting If you think you may have hyponatraemia, [nhs.uk]

• Lethargy

  She had a 3-month history of lethargy, reduced appetite, weight loss, cough and intermittent fevers. [ncbi.nlm.nih.gov]

  If you lose too much water, you could have: Unexplained weakness Lethargy Muscle pains Irritability How Is It Diagnosed? If you have this condition, you’ll probably wind up at the doctor for help with your thirst and constant need for a bathroom. [webmd.com]

  In children, additional symptoms of CDI can include lethargy, irritability, growth retardation, weight loss, fever, vomiting or diarrhea. In secondary CDI, further manifestations may be present resulting from the secondary cause. [orpha.net]

  Case presentation A thirty year old female with adenocarcinoma of rectum was admitted with increasing lethargy, headache and drowsiness. She deteriorated rapidly and had cardiac arrest, following which she remained comatose. [bmcresnotes.biomedcentral.com]

• Confabulation

  On year 5 after the cardiac surgery, patient presented with sleepiness, hyperphagia, memory loss, confabulation, dementia and diabetes insipidus. [ncbi.nlm.nih.gov]

• Myoclonus

  Clinical details of patients Patient Sex Age Etiology of ADI Anterior pituitary dysfunction Associated conditions A F 39 Surgery to ACAA No Nil B M 30 Surgery to ACAA No Mild left hemiparesis C M 28 Surgery to ACAA No Myoclonus, absence attacks, hypothermia [doi.org]

• Polyuria

  The water deprivation test with assessment of AVP activity is currently the gold standard for differential diagnosis in patients presenting polyuria-polydipsia syndrome. [ncbi.nlm.nih.gov]

  Introduction The determination of a specific diagnosis in patients with polyuria and low plasma osmolality (i.e., hypotonic polyuria) is a frequent problem in clinical practice. [doi.org]

  The first step in the diagnosis of the patient with polyuria is determining whether the polyuria is due to a solute diuresis or a water diuresis. [clinicaladvisor.com]

• Nocturia

  Additionally, patients develop the need to urinate at night (nocturia), leading to sleep deprivation and daytime sleepiness. Desmopressin, a synthetic ADH analog, is the treatment of choice in central DI. [amboss.com]

  During her first week of treatment, she developed polyuria, nocturia and polydipsia and was diagnosed with central diabetes insipidus. [ncbi.nlm.nih.gov]

  What is nocturia? Nocturia is when a person has to wake up at night to pass urine. If this happens more than twice a night, it can be a problem. Nocturia is common in older people. It can cause problems in day-to-day life. [continence.org.au]

  Signs and symptoms  Polyuria with urine output of 5 to 15 L daily  Polydipsia, especially a desire for cold fluids  Marked dehydration, as evidenced by dry mucous membranes, dry skin, and weight loss  Anorexia and epigastric fullness  Nocturia and [slideshare.net]

• Nocturnal Polyuria

  Dosing is started at night to give relief for nocturnal polyuria, and day-time dosages are added as per need to control day-time symptoms. It can be given nasally, parenterally, or orally. Oral preparation is preferred for patients with sinusitis. [hindawi.com]

The diagnosis of diabetes insipidus is established by the use of the following investigations [6].

• Plasma osmolality: Since the amount of antidiuretic hormone is not measurable in the serum, the osmolality of the plasma is tested. It is significantly raised in diabetes insipidus. A plasma osmolality greater than 300 mOsm/kg is diagnostic of diabetes insipidus.
• Urine osmolality: The osmolality of the urine is less than 600 mOsm/kg in diabetes insipidus.
• Water deprivation test: The objective of water deprivation test is to establish the diagnosis of diabetes insipidus and to determine whether the cause is central or nephrogenic. In central diabetes insipidus, the osmolality of urine increases from less than 600 mOsm/kg to over 660 mOsm/kg after the administration of desmopressin, an analogue of anti-diuretic hormone. In nephrogenic diabetes insipidus, the concentration of the urine remains the same even after the administration of desmopressin.

• Pericardial Effusion

  Transthoracic heart ultrasound revealed large pericardial effusion and a heterogeneous mass that compressed the right ventricle. No osteosclerotic lesions on appendicular bones were present. [ncbi.nlm.nih.gov]

• Lymphocytic Infiltrate

  Cases of lymphocytic hypophysitis were possibly classified as idiopathic prior to improved imaging studies. This disorder is characterized by lymphocytic infiltration of the stalk and posterior pituitary. [emedicine.medscape.com]

Rehydration

The patients suffering from diabetes insipidus have to be rehydrated with intravenous or oral fluids depending upon their severity of dehydration.

Central diabetes insipidus

An analog of antidiuretic hormone called desmopressin is the treatment of choice for central diabetes insipidus. The bioavailability of desmopressin in oral form is negligible. Therefore, it is usually given in the form of nasal spray. It may also be given intramuscularly if the patient is acutely ill [7].

Nephrogenic diabetes insipidus

Thiazide diuretics have a paradoxical effect and decrease polyuria in both central and nephrogenic diabetes insipidus. A combination of indomethacin and hydrochlorothiazide or indomethacin and amiloride may be used in nephrogenic diabetes [8] [9] [10]. In addition, the use of low salt diet may be advised to reduce thirst and to lower the excretion of water.

With proper treatment, the prognosis for the people suffering from diabetes insipidus is excellent. Central diabetes insipidus responds to treatment much more easily than nephrogenic diabetes insipidus.

Although the patients of diabetes insipidus rapidly become dehydrated, mortality from it is rare in previously healthy adult patients. Children and the elderly are at a higher risk of mortality from severe dehydration.

Diabetes insipidus is of two types, central and nephrogenic.

Central diabetes insipidus

Central diabetes insipidus results from deficient production of antidiuretic hormone (ADH) in the hypothalamus or their inability to reach the posterior pituitary from where they are released in the blood [1]. It is most commonly associated with hypothalamic or high stalk lesions such as craniopharyngioma, sarcoidosis, histiocytosis X, tuberculous meningitis, encephalitis and syphilis [2]. Head injuries and surgeries may also cause damage to the hypothalamus. Pituitary tumors with suprasellar extension or metastases to the pituitary may also cause central diabetes insipidus. Central diabetes insipidus may also have idiopathic or genetic etiologies [3].

Nephrogenic diabetes insipidus

It results from the lack of response of renal tubules to antidiuretic hormone [4]. It is associated with renal damage with may result from genetic defects (sex linked recessive defects, cystinosis), metabolic abnormalities (such as hypokalemia and hypercalcemia), drug therapy (with lithium or demeclocycline) or heavy metal poisoning. It may also be caused by other conditions such as pyelonephritis, renal amyloidosis, multiple myeloma and Sjogren syndrome.

Not much data is available regarding the epidemiology of diabetes insipidus. However, it is a rare disease with a prevalence of 3 per 100,000 people in the United States [5]. The prevalence is equal in men and women. Various ethnic groups also have equal tendencies for the development of diabetes insipidus.

Antidiuretic hormone is a nonpeptide hormone that is formed in the hypothalamus and stored in the posterior pituitary. Its primary effect is on the epithelial cells of the renal collecting tubules where it augments the resorption of water independently of the solutes. This causes dilution of the blood serum and concentration of the urine.

Diabetes insipidus results due to a decreased effect of antidiuretic hormone. The cause may be central or nephrogenic. Central diabetes insipidus results from an ineffective production of antidiuretic hormone; whereas in nephrogenic diabetes insipidus, the cells of the kidney fail to respond to it.

There are no documented ways to prevent the development of diabetes insipidus.

Diabetes insipidus is an endocrine disease characterized by the persistent excretion of excessive quantities of dilute urine and constant, excessive thirst. It results from a decreased action of antidiuretic hormone - the posterior pituitary hormone that is responsible for the suppression of urination by increasing the resorption of water in the renal collecting tubules. It may be due to a decreased production of antidiuretic hormone or the inability of the renal cells to respond to it.

Diabetes insipidus is treated by the administration of desmopressin (an analog of antidiuretic hormone) along with thiazide diuretics. The disease is fatal unless adequate rehydration and proper treatment is ensured.

The pituitary gland is a small gland located at the base of the brain. One of the hormone it secretes is called antidiuretic hormone. This hormone acts on the kidneys and causes absorption of water back into the blood, thereby preventing the excessive loss of water in the urine. In diabetes insipidus, there is either a reduced production or inadequate effect of antidiuretic hormone which causes the loss of a large amount of water in the urine. The patients develop dehydration and excessive thirst. With proper treatment, there is an excellent control of the disease.

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