General Practice 2022

Diabetes insipidus: what é, symptoms, causes and treatment

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Diabetes insipidus: what é, symptoms, causes and treatment
Diabetes insipidus: what é, symptoms, causes and treatment

Diabetes insipidus is a disorder that occurs due to an imbalance of fluids in the body, which leads to symptoms such as being very thirsty, even if you have drunk water, and excessive production of urine, which can cause dehydration.

This condition occurs due to changes in regions in the brain responsible for the production, storage and release of antidiuretic hormone (ADH), also called vasopressin, which controls the rate at which urine is produced, but it can also occur due to alterations in the kidneys that stop responding to this hormone.

Diabetes insipidus has no cure, however, treatments, which must be prescribed by the doctor, can relieve excess thirst and decrease urine production.

Main symptoms

Symptoms of diabetes insipidus are uncontrollable thirst, production of large amounts of urine, frequent need to get up to urinate during the night, and a preference for drinking cold liquids. In addition, over time, excessive fluid consumption causes worsening sensitivity to the hormone ADH or decreasing production of this hormone, which can worsen symptoms.

This disease can also occur in babies and children and because of the excessive production of urine it is important to be aware of the signs of diabetes insipidus such as always wet diapers or the child may wet the bed, difficulty sleeping, fever, vomiting, constipation, delay in growth and development, or weight loss.

How to confirm the diagnosis

The diagnosis of diabetes insipidus should be made by an endocrinologist or, in the case of infants and children, a pediatrician, who should request a 24-hour urine volume test and blood tests to assess sodium and potassium, which may be altered.In addition, the doctor may order a fluid restriction test, in which the person is hospitalized without drinking and is monitored for signs of dehydration, amount of urine produced and hormone levels. Another test that the doctor may order is an MRI of the brain to evaluate changes in the brain that may be triggering the disease.

Possible causes

The causes of diabetes insipidus depend on the type of disease and can be classified as:

1. Central diabetes insipidus

Central diabetes insipidus is caused by changes in the region of the brain called the hypothalamus, which loses the ability to produce the hormone ADH, or the pituitary gland responsible for storing and releasing ADH into the body and can be caused by:

  • Brain surgeries;
  • Head trauma;
  • Brain tumor or aneurysm;
  • Autoimmune diseases;
  • Genetic diseases;
  • Brain infections;
  • Obstruction of blood vessels supplying the brain.

When the levels of the hormone ADH are reduced, the kidneys cannot control the production of urine, which is formed in large quantities, so the person urinates a lot, which can reach more than 3 to 30 liters per day.

2. Nephrogenic diabetes insipidus

Nephrogenic diabetes insipidus occurs when the concentration of the hormone ADH in the blood is normal, but the kidneys do not respond normally to it. The main causes are:

  • Use of medication, such as lithium, rifampicin, gentamicin or test contrast agents, for example;
  • Polycystic kidney disease;
  • Severe kidney infections;
  • Changes in blood potassium levels;
  • Diseases such as sickle cell anemia, multiple myeloma, amyloidosis, sarcoidosis, for example;
  • Post kidney transplantation;
  • Kidney cancer;
  • Unclarified or idiopathic causes.

Furthermore, there are genetic causes for nephrogenic diabetes insipidus, which are rarer and more severe, and manifest from childhood.

3. Gestational diabetes insipidus

Gestational diabetes insipidus is a rare condition, but it can happen around the third trimester of pregnancy due to the production of an enzyme by the placenta, which destroys the woman's ADH hormone, leading to the onset of symptoms.

However, it is a disease that only occurs during pregnancy, normalizing around 4 to 6 weeks after delivery.

4. Dipsogenic diabetes insipidus

Dipsogenic diabetes insipidus, also called primary polydipsia, can occur due to damage to the hypothalamic thirst regulation mechanism, leading to the appearance of the common symptoms of diabetes insipidus.This type of diabetes can also be related to mental illnesses, such as schizophrenia, for example.

How the treatment is done

Treatment for diabetes insipidus aims to reduce the amount of urine the body produces and should be prescribed by the doctor according to the cause of the disease.

In cases where diabetes insipidus has been caused by the use of certain medications, the doctor may recommend discontinuing use and switching to another type of treatment. In cases of mental illness, treatment must be carried out by a psychiatrist with specific medications for each case, or if diabetes insipidus has been caused by an infection, for example, the infection must be treated before starting a specific treatment.

In general, the types of treatment depend on the severity of the disease and the type of diabetes insipidus, and can be done with:

1. Control of fluid intake

In mild cases of central diabetes insipidus, the doctor may recommend only controlling the amount of fluid ingested, being recommended to drink at least 2.5 liters of fluids per day to avoid dehydration.

Central diabetes insipidus is considered mild if the person produces only 3 to 4 liters of urine in 24 hours.

2. Hormone

In more severe cases of central diabetes insipidus or gestational diabetes insipidus, the doctor may recommend replacing the hormone ADH, through the medication desmopressin or DDAVP, which can be administered by vein, orally or by inhalation.

Desmopressin is a more potent hormone and more resistant to degradation than the body's naturally produced ADH and works just like natural ADH, preventing the kidneys from producing urine when the body's water level is low.

3. Diuretics

Diuretics can be used, especially in severe cases of nephrogenic diabetes insipidus. excreted by the body.

Also, your doctor should recommend a low-s alt diet to help reduce the amount of urine your kidneys produce and drink at least 2.5 liters of water a day to prevent dehydration.

4. Anti-inflammatories

Anti-inflammatory drugs, such as ibuprofen, may be indicated by the doctor in cases of nephrogenic diabetes insipidus, as they help to reduce the volume of urine and should be used in combination with diuretics.

However, using anti-inflammatories for a long time can cause stomach irritation or the appearance of a stomach ulcer. In this case, the doctor may recommend a medicine to protect the stomach such as omeprazole or esomeprazole, for example.

Possible complications

The complications that diabetes insipidus can cause are dehydration or imbalance of electrolytes in the body such as sodium, potassium, calcium and magnesium, due to the large loss of fluids and electrolytes by the body through the urine, which can cause symptoms such as:

  • Dry mouth;
  • Headache;
  • Dizziness;
  • Confusion or irritability;
  • excessive fatigue;
  • muscle pain or cramps;
  • Nausea or vomiting;
  • Loss of appetite.

If you have one of these symptoms, seek medical help immediately or the nearest emergency room.

What is the difference between diabetes insipidus and mellitus?

Diabetes insipidus is different from diabetes mellitus, as the hormones that change in these two types of diabetes are different.

In diabetes insipidus there is a change in the hormone ADH that controls the amount of urine the person produces. In diabetes mellitus, there is an increase in blood glucose levels due to low insulin production by the body or a resistance of the body to respond to insulin.Check out other types of diabetes.

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