Diabetes insipidus-
Diabetes insipidus https://healthuseful.com/diabetes-insipidus/ this is a rare disorder in which too much urine is produced by kidneys-more than 20 quarts. The diabetes which we talk about in day to day language is diabetes mellitus -which is related to altered levels of blood glucose in our blood. Diabetes insipidus is a totally different thing. In this there is disorder of salt and water metabolism
Statistics –
In India this disorder is a very, very rare occurrence.
Symptoms of diabetes insipidus –
In this the individual complains of excessive thirst, frequent and heavy micturition, getting up frequently at night time, bed wetting. In small children in addition to these there may be constipation, delayed growth weight loss fever, vomitting due to extreme loss of body water there occurs high concentration of chemical ingredients in blood. Excess concentration of sodium in blood can result in hypernatraemia-which can lead to confusional state-altered sensorium.
Causes /Etiology of Diabetes insipidus –
Kidneys do the work of filtering the blood. During this process initially some amount of fluid is filtered by the kidneys. But some amount of this as to be returned to the blood stream as the work of kidney is to excrete only the harmful waste products along with certain amount of water . The work of regulating as to how much amount of water and salt is to be excreted by the kidneys is done by ADH(Antidiuretic hormone) or Vasopresin
ADH(Antidiuretic hormone) or Vasopressin is hormone which is produced by hypothalamus in brain and it is stored in pituitary gland which is located in the cranial cavity inferior to brain .
If the production of ADH is inhibited or its effects are blocked then diabetes insipidus can result .
On basis of this there are 2 types of diabetes insipidus –
Central diabetes insipidus
In this the production of ADH can be inhibited due to Surgery Tumour Trauma Genetic/Hereditay Any condition that can cause brain damage -stroke due to ischaemia causing infarction due to drowning, suffocation due to any cause or stroke due to bleeding due to trauma or hypertensive stroke Infection due to encephalitis, meningitis Wolfram syndrome a genetic disorder that can also result in loss of vision.
Any condition affecting the production storage, release of ADH.
Nephrogenic Diabetes insipidus –
In this case there is no problem with the production and storage of ADH but there are some changes occured in the kidneys which make them less responsive to the action of ADH. Some examples of these are. –
1 Genetic/Heriditary.
2 Renal diseases. which are chronic in nature.
Iatrogenic
This can occur as a result of some drugs given to patient when admitted in hospital like Lithium.
Gestational diabetes insipidus – This is rare, in this during pregnancy an enzyme it’s produced by placenta .This enzyme destroys ADH
Primary polydipsia –
This can occur if there is damage to the thirst regulating mechanism of the hypothalamus.
Autoimmunity-
In this due to autoimmunity the immune system of the individual is mal-functioning and it destroys the individual ‘s own renal tubules of the kidney and this results in diabetes insipidus. So in this the central component (Hypothalamus and Pituitary gland) are working very well, but it still results in diabetes insipidus.
If any individual is to be diagnosed with this disorder -diabetes insipidus -then consultation with a qualified and experienced Nephrologist/MD-General Medicine will be required.
Treatment –
Treatment of diabetes insipidus consists of replenishing the large amounts of water that is lost by kidneys, by asking the patient to drink lot amount of water.
If the patient is not in a condition to drink water then he should be hospitalized and iv fluids should be given.
Low salt diet should be given Antidiuretics and SOS Diuretics (to be decided by the Nephrologist or physician -MD-General Medicine) who is in charge of the treatment given to the patient .
A synthetic hormone Desmopressin is administered to patient to compensate for the loss of natural ADH(anti diuretics) hormone. Desmopressin is available in the form of nasal spray tablet.
Injection –
Thanks to the tremendous development in science and technology -due to which mankind is now able to conquer most of the diseases. But still now there are many diseases and disorders which are not fully understood by modern science and so mankind is still desperate with them .Hopefully in future further advancement in science and technology will give us success in this regard.
Diagnosis of Diabetes insipidus –
Water deprivation test -In this the patient is first admitted to hospital.
He is not allowed to drink water nor he is given in fluids.
When there is low intake of water ADH is produced by the body to conserve water and then the blood levels of ADH, urine output ,concentration of urine, concentration of blood and are measured . Then synthetic desmopressin (ADH) is administered to patient and before that with the help of ADH level in blood it is found out whether body is producing sufficient ADH.After giving ADH it is found out if the kidneys are responding to ADH. Thus we can differentiate between Nephrogenic Diabetes Insipidus and Central Diabetes Insipidus. If there is no response even after giving ADH then it means that it is Nephrogenic diabetes insipidus.
MRI brain –
MRI brain is the investigation of choice in case of soft tissues .Due to MRI high intensity magnetic field is used to make white ,black and grey images. The main focus of MRI brain is to look for any pathology related to the pituitary gland and the area surrounding the pituitary gland. This can give information regarding any pituitary tumors, if any signs of damage to pituitary in case of any accidents or any other thing.
Genetic screening is required in those who have a family history of excess urination. From this we can find out if this disorder is running in families.
