Diabetes Insipidus

Diabetes Insipidus is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Disorder in which large volumes of dilute urine are excreted (polyuria) as an inappropriate response to arginine vasopressin (AVP)
  • Polyuria defined as >3 L in 24 hr
  • Often characterized by excessive fluid intake (polydipsia)
  • 2 types:
    • Central diabetes insipidus (DI, CDI; failure or deficiency of AVP release):
      • 4 types:
        • No AVP to release (loss or malfunction of posterior pituitary neurons)
        • Defective osmoreceptors—release AVP only in response to severe dehydration
        • Elevated threshold for AVP release
        • Subnormal amount of AVP released
      • Familial cases have been reported (autosomal dominant).
    • Nephrogenic DI (lack of renal response to AVP):
      • Differentiate from primary polydipsia.
      • Some cases are X-linked recessive in males.

Etiology

  • Central DI:
    • Any condition that disrupts the osmoreceptor-hypothalamus-hypophyseal axis:
    • Highest incident in ages 10–20 yr
      • Trauma (skull fractures, hemorrhage)
      • Pituitary or hypothalamic surgery
      • CNS neoplasm: DI can be considered a tumor marker:
        • Pituitary adenomas
        • Craniopharyngiomas
        • Germinomas
        • Pinealomas
        • Meningiomas
      • Metastatic tumors:
        • Leukemia/lymphoma
      • Granulomatous:
        • Histiocytosis
        • Sarcoidosis
      • Congenital CNS defects
      • CNS infections (e.g., meningitis, encephalitis)
      • Pregnancy (Sheehan syndrome)
      • Idiopathic (autoantibodies, occult tumor)
      • Wolfram syndrome (DI, DM, optic atrophy, deafness)
      • Ethanol
  • Nephrogenic DI:
    • Any condition that disrupts the kidney:
      • Congenital renal disorders
      • Obstructive uropathy
      • Renal dysplasia
      • Polycystic kidney disease
      • Systemic disease with renal involvement
      • Sickle cell disease
      • Sarcoidosis
      • Amyloidosis
      • Drugs:
        • Amphotericin
        • Phenytoin
        • Lithium (most common and persists past discontinuation of drug)
        • Aminoglycosides
        • Methoxyflurance
        • Demeclocycline
      • Electrolyte disorders:
        • Hypercalcemia
        • Hypokalemia

Pregnancy Considerations
  • Transient in the 2nd trimester:
    • Unclear etiology, but there is an increase of circulating vasopressinase.
    • Leads to a decrease in AVP and transient DI
    • Watch patient closely during anesthesia and periods of water restriction.
    • Typically clears after 2–6 wk after delivery
    • Desmopressin (DDAVP) resists this vasopressinase.
  • Sheehan syndrome may cause DI.

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Citation

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TY - ELEC T1 - Diabetes Insipidus ID - 307104 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307104/all/Diabetes_Insipidus ER -