Understanding Diabetes Insipidus (DI): Causes, Symptoms, and Management

What is it?

Diabetes insipidus is a rare disorder that causes the body to produce large amounts of dilute urine. There are different types of DI, each caused by different mechanism. Central DI- is when damage in the hypothalamus or the pituitary gland causes an unsatisfactory production of the Vasopressin hormone. This hormone is important for the retention of fluids. In Nephrogenic DI - although there is enough Vasopressin, the kidneys fail to respond properly, resulting in water wasting. Dipsogenic DI is when the thirst mechanism in the hypothalamus is damaged and is more common in psychiatric disorders.

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Signs & symptoms

Excessive urination, severe thirst and increased fluid intake- preference for cold drinks, getting up at night, dehydration, fatigue, dizziness, confusion, nausea, weakness, muscle pains and irritability. In infants DI can present with crankiness, failure to thrive and poor feeding. In children a new bedwetting can be a sign for DI.

Diagnosis

In a 24- hour urine test, collecting over 3.5 liters of urine is defined as polyuria. Then, a fluid deprivation test is performed in order to measure changes in body weight,urine sodium concentration and blood osmolality. Urine osmolality higher than 600 meq/l rules out DI. Low urine osmolality (which means urine is dilute) along with high plasma osmolality (blood is concentrated) will indicate there is an injury that falls under the category of DI.
To distinguish central from nephrogenic DI an exogenous ADH is given. If urine osmolality increases, it means there was a a response to the hormone administration and indicates that the problem is central, then a brain MRI can be performed.

Treatment

For central DI, exogenous ADH like desmopressin may be prescribed. Nephrogenic DI is harder to treat, sometimes diuretics such as Thiazide or Amiloride are given to ease the symptoms.

☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.

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Source of Information - We analyze big data of more than 23 million patients de-identified medical records from the following sources:

National Institution of Health ∙ World Health Organization ∙ University of Illinois hospital