Definition

Diabetes insipidus, often known as water diabetes, is a kind of diabetes that is characterized by extreme thirst and frequent urination. Diabetes insipidus is different from diabetes mellitus despite the presence of overlapping signs and symptoms.

If you want to know more about Diabetes Mellitus, read it here: Diabetes Melitus Understanding, Cause, Symptoms, And Treatment.

A person with severe diabetes insipidus may excrete as much as 20 litres of urine per day. Depending on the underlying cause, diabetes insipidus can be either chronic or temporary, as well as moderate or severe.

In the United States of America, the incidence of diabetes insipidus is three cases per 100,000 people. It is estimated that four instances of gestational diabetes insipidus occur for every 100,000 pregnancies.

Causes

Angiotensin II (Vasopressin), or anti-diuretic hormone (ADH), dysfunction initiates the development of diabetes insipidus. ADH is essential for the regulation of fluid balance in the body. This hormone is produced in the hypothalamus.

ADH is transported from the hypothalamus to the pituitary gland, depositing until the body requires it. When the body's water content is insufficient, the pituitary gland secretes ADH. Its function is to help in water retention by decreasing water loss through the kidneys, thereby increasing the urine concentration produced by the kidneys.

Diabetes insipidus is characterized by insufficient synthesis of antidiuretic hormone (ADH), resulting in the kidneys' inability to produce urine with adequate concentration, leading to excessive body water loss.

Classifications of Diabetes Insipidus

Diabetes insipidus is categorized into multiple categories based on its underlying cause, which include:

• Central Diabetes Insipidus

Central diabetes insipidus can be caused by damage to the pituitary gland or hypothalamus resulting from surgery, tumor, head injury, or disease. This damage affects the production, storage, and release of ADH.

• Nephrogenic Diabetes Insipidus

Nephrogenic diabetes insipidus is characterized by renal structural damage that inhibits the kidneys' ability to respond effectively to antidiuretic hormones (ADH). This can be attributed to either congenital (genetic) problems or chronic kidney diseases.

• Gestational Diabetes Insipidus

Gestational diabetes insipidus is a medical condition characterized by the inability of the kidneys to control the concentration of urine during pregnancy effectively. In pregnant women, placental enzymes may eliminate ADH. Gestational diabetes insipidus is an uncommon condition.

• Primary Polydipsia

It is sometimes referred to as dipsogenic diabetes insipidus. Primary polydipsia is caused by a hypothalamic injury that affects the thirst-regulating mechanism. Schizophrenia has been associated with this disorder.

Risk Factor

Several risk factors associated with diabetes insipidus include:

• Family history of diabetes insipidus
• Undergone brain surgery or suffered a severe head injury.
• Consuming drugs with potential nephrotoxicity.
• Experience specific metabolic disorders, such as hypercalcemia or hypokalemia.
• Twin pregnancies, preeclampsia, HELLP syndrome, and other disorders that impact liver function increase a pregnant woman's risk of developing gestational diabetes insipidus.

Read more about preeclampsia here: Preeclampsia Understanding, Cause, Symptoms, And Treatment

A congenital (genetic) factor that permanently reduces the kidney's ability to concentrate urine is typically the cause of nephrogenic diabetes insipidus, which appears immediately after birth. Nephrogenic diabetes insipidus is a condition that primarily affects men; however, women can transmit this gene to their children.

Symptoms

Diabetes insipidus exhibits various indications and symptoms that are similar to those of diabetes mellitus, including:

• Persistent thirst throughout the day
• Increased frequency of urination
• Excessive volume of urinary output
• Transparent or not intensely pigmented color of urine
• Nighttime urination (nocturia)
• Fatigue due to sleep disturbances from frequent nighttime urination

Diagnosis

The diagnosis of diabetes insipidus can be confirmed through medical interviews, physical examinations, and, if necessary and accessible, additional examinations.

During the medical interview, the doctor will inquire about the patient's present symptoms, including excessive thirst, frequency of urination, and any family history of diabetes insipidus. Following the medical interview, the following assessment is a physical examination. During this part of the procedure, essential vital signs are monitored, specifically blood pressure, respiratory rate, pulse rate, and body temperature.

If a further evaluation is required, the doctor may perform additional examinations, which may include:

• Water scarcity examination

This test is conducted under the guidance of a doctor or healthcare team. You will be required to abstain from consuming liquids for a prolonged period. In situations where fluid intake is limited, the antidiuretic hormone (ADH) allows the kidneys to decrease the volume of urine produced, thus preventing dehydration. During fluid restriction, your doctor will monitor fluctuations in your body weight and urine production, as well as the concentrations of urine and blood.

• Vasopressin test

During a water scarcity test, the doctor will administer synthetic antidiuretic hormone (ADH) to evaluate the levels of ADH in the circulation. This test will determine the adequacy of your body's antidiuretic hormone (ADH) production and the responsiveness of the kidneys to ADH.

• The hypertonic saline infusion test

An intravenous solution containing water and salt will be administered, and then the patient's blood will be tested for particle concentration and vasopressin levels.

• Genomic screening

Genomic screening is indicated if anyone in your family has excessive urination.

Radiological Examination

• Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) is a diagnostic tool that can search for abnormalities in or around the pituitary gland. The test is considered non-invasive as it combines a powerful magnetic field and radio waves to generate detailed visuals of brain tissue.

Management

Treatment for diabetes insipidus differs according to the type of diabetes, which includes:

• Central Diabetes Insipidus

Desmopressin, a synthetic hormone, is an effective treatment for this condition. This medication serves as a replacement for depleted ADH and decreases the frequency of urine. Desmopressin can be administered in several formulations, including tablets, nasal sprays, or injections.

• Nephrogenic Diabetes Insipidus

Consume a low-salt diet to decrease urine production and drink plenty of water to stay hydrated. Hydrochlorothiazide can be used as an additional treatment option for symptoms.

• Gestational Diabetes Insipidus

The treatment for gestational diabetes insipidus involves the injection of the synthetic hormone desmopressin.

• Primary polydipsia

There is no targeted therapy available for this particular type of diabetes insipidus except for the reduction of fluid consumption. Treating the mental disorder associated with the condition may help relieve the symptoms of diabetes insipidus.

Complications

Dehydration

Dehydration is the primary consequence of diabetes insipidus, resulting from excessive loss of fluid and electrolytes from the body. Among the symptoms are:

• Dry mouth (xerostomia)
• Skin inelasticity
• Severe thirst

Fluid rehydration is an effective treatment for mild dehydration. On the other hand, the condition of extreme dehydration necessitates medical intervention at a hospital.

Electrolyte Imbalance

Diabetes insipidus induces dehydration and disrupts the balance of electrolytes and minerals in the blood, including sodium and potassium, which regulate body fluids.

Common manifestations of electrolyte imbalance may include:

• Fatigue
• Nausea
• Vomiting
• Appetite loss
• Muscle cramps
• Disorientation

Prevention

Diabetes insipidus leads to excessive dehydration as a result of significant urinary fluid excretion. The most effective measure is to ensure adequate fluid intake to prevent dehydration. It is recommended to bring drinking water with you wherever you go.

When to see a doctor?

In normal conditions, adults urinate four to seven times every twenty-four hours; however, children may urinate more frequently due to the smaller size of their bladders.

Seek medical attention as soon as possible if you experience persistent feelings of thirst, if you have to urinate more than ten times per day, or if the color of your urine is clear. These symptoms may indicate an electrolyte imbalance.

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