Ver el código de «Diabetes insipidus»

==Background==
*Characterized as either:
**Central Diabetes Insipidus (or neurogenic DI)
***Deficient secretion of antidiuretic hormone (ADH)
**Nephrogenic DI 
***Normal ADH secretion but decreased renal sensitivity to ADH
*Causes [[hypernatremia]]

===Causes===
*Central DI
**Cancer
**Pituitary surgery
**[[Head trauma]]
**Idiopathic
*Nephrogenic DI
**[[renal failure|Renal disease]]
**Drug Induced (e.g [[Lithium]])
**[[Hypokalemia]]
**[[Hypercalcemia]]
**[[Polycystic kidney disease]]
**[[Sjögren syndrome]]
**[[Amyloidosis]]

==Clinical Features==
*[[Hypernatremia]]
*Decreased urine osmolality
*[[Dehydration]]
*Irritability
*[[Tremor]]s
*[[Ataxia]]
*Hyperreflexia
*Spasms
*[[Seizures]]
*Death

==Differential Diagnosis==
{{Hypernatremia causes}}

==Evaluation==
*Urine specific gravity < 1.010
*Measure serum and urine sodium while patient is water-deprived
**Lack of response to water deprivation is diagnostic
**Serum Osm >295 mOsm/L
*Record response to 5 units subcutaneous [[vasopressin]]  
**Response to [[vasopressin]] is diagnostic of central DI (response is indicated by urine osm >800 mOsm/L)
**No response is diagnostic of nephrogenic DI
*In adults, onset of central DI usually abrupt whereas onset gradual in nephrogenic DI

==Management==
*Place foley for strict I/Os
*Volume repletion with [[normal saline]] or lactated ringers solution
*Patients will be water-deprived
**Calculate water deficit: Water deficit (in Liters) = [(Body weight(kg)x0.6)x((Measured sodium/Normal sodium)-1)]
*Serum sodium should not decrease by more than 10-15 mEq/L per day in chronic cases of hypernatremia
**Over-aggressive reduction of serum sodium may result in cerebral edema secondary to presence of idiogenic osmoles the build up in brain cells when exposed to chronic hypernatremia
**If patient acutely hypernatremic, idiogenic osmoles have not had time to build up in brain tissue and rapid correction of hypernatremia would not develop cerebral edema

*Nephrogenic diabetes insipidus<ref>Bichet DG et al. Treatment of nephrogenic diabetes insipidus. UpToDate. Jan 7, 2016. http://www.uptodate.com/contents/treatment-of-nephrogenic-diabetes-insipidus#H10</ref>
**Low-salt, low-protein diet
**[[Hydrochlorothiazide]] 25mg BID
**[[Indomethacin]] has greater effect at reducing urine output than ibuprofen

==Disposition==
*Admission for further workup and/or volume replacement
*Nephrology follow up

==See Also==
*[[Hypernatremia]]

==External Links==

==References==
<references/>

[[Category:Endocrinology]][[Category:FEN]]