Diabetes insipidus - Causes, Symptoms and Treatment .MF .
The term "diabetes insipidus" united diseases characterized by the release of large amounts of dilute urine.Most often, these diseases are associated with impaired production or action of antidiuretic hormone (ADH).
The body has a complex system for balancing the volume and composition of the liquid.The kidneys, removing excess fluid from the body to form urine, which is stored in the bladder.When the water consumption is reduced, or there is a loss of water (excessive sweating, diarrhea), renal urine will produce less, to maintain the liquid in the body.Hypothalamus - a brain region responsible for the regulation of the entire endocrine system produces antidiuretic hormone (ADH), also called vasopressin.ADH "stored" in the pituitary gland, which is located near the hypothalamus at the base of the brain.When ADH reaches the kidney, it causes reabsorption into the blood stream of water, that is reducing the amount of urine.Just ADH acts on the blood vessels, causing them narrowing, but this effect appea
There are four types of diabetes insipidus:
1) central diabetes insipidus
2) Nephrogenic diabetes insipidus
3) dipsogenny diabetes insipidus
4) gestational diabetes insipidus.
diabetes insipidus - a fairly rare disease, in contrast to diabetes.Diabetes mellitus is a result of insulin deficiency or insulin resistance and causes an increase in glucose (sugar) blood.Recall that diabetes menacing its complications, it is a cause of morbidity and high mortality.And diabetes insipidus - a disease with a favorable prognosis.These two diseases are not related to each other, although they may have similar signs and symptoms such as increased thirst and excessive urination.
Symptoms of diabetes insipidus
main symptom of diabetes insipidus is the allocation of large amounts of urine.Mild forms of diabetes insipidus cause fluid loss from 2.5 to 2 liters per day, in severe cases, the urine volume up to 20 liters per day.Due to the loss of fluid a person with diabetes insipidus feel thirsty, need to drink plenty of beverages, most patients prefer cold drinks, because they better satisfy thirst.Frequent urination, including during the night can cause sleep disturbance, and in some cases cause bedwetting.In connection with the release of abnormally large volumes of dilute urine, people with diabetes insipidus can threaten dehydrated if they do not drink enough water.Dehydration is very dangerous, because in the first place is suffering from a lack of fluid the central nervous system.The defeat of the central nervous system can cause symptoms such as irritability, or, conversely, lethargy, fever, vomiting or diarrhea, lethargy and even coma.Therefore with thirst in patients with diabetes insipidus should never limit your intake of fluids!
diagnosis of diabetes insipidus
In most cases, the difficulties does not constitute diagnosis of diabetes insipidus.
The first phase establishes the fact of having diabetes insipidus using clinical signs (complaints of thirst, frequent, copious) and urine tests, indicating a decrease in its concentration.
In general, the analysis of a morning urine sample can detect an increase in the amount of urine, reducing the proportion.Very common Ziminitskogo sample.For it is required of the urine collection during the day 8 containers, one container is designed for 3 hours.Further, in each portion determined by the amount and specific gravity.Urine is a person with diabetes insipidus will be less concentrated in all portions.
In cases of doubt, the test is carried out with the deprivation of fluid.This test is quite complicated, should be performed only in a hospital, is rarely used.
also necessary to exclude diabetes by determining the blood glucose level.
On peculiarities of each type of diagnosis of diabetes insipidus will be described below.
treatment of diabetes insipidus
Central diabetes insipidus
most common and serious form of diabetes insipidus is diabetes insipidus of central origin as a result of damage to the pituitary gland.Damage to the pituitary gland may be caused by various causes: tumors of the pituitary gland and the hypothalamus, infectious diseases, brain injuries, neurosurgical intervention, or genetic disorders.
necessary to carry out magnetic resonance imaging (MRI) of the brain to determine the cause of central diabetes insipidus.Sometimes the cause of central diabetes insipidus can not be identified, then it is called idiopathic.
For the treatment of ADH deficiency arising from damage to the hypothalamus or pituitary gland, a synthetic analogue of the hormone desmopressin (Presayneks, Vazomirin, Minirin, Nativ) as a nasal spray or tablets.Taking desmopressin, a person should drink fluids only with lust, and not at other times.The preparation promotes water reuptake in the kidney, and water may accumulate in the body, causing water intoxication.Desmopressin dosage is adjusted individually.Typically, the average daily dose for adults - 10-40 g, for children - 10-20 mg.The daily dose may be taken once, it is also possible to divide it into two, rarely three reception.Typically, the drug is well tolerated.
By side effects of the drug desmopressin include headache, dizziness, impairment of consciousness, intestinal colic, nausea, vomiting, mild increase in blood pressure, menstrual irregularities, skin rash.Before the drug in the form of a spray or nasal drops possible swelling of the nasal mucosa.
In no event should not take the drug without a prescription, guided by the presence of symptoms such as thirst and frequent urination.Admission desmopressin in nephrogenic, dipsogennom diabetes insipidus is contraindicated, can lead to serious complications.
Patients taking desmopressin intranasal formulations, iein the form of drops or a spray in the nose, it should be remembered that when there is a cold swelling of the nasal mucosa, and may reduce the absorption of the drug.In these cases it is recommended sublingual formulation, ieunder the tongue.
Nephrogenic diabetes insipidus
Nephrogenic diabetes insipidus is the result of the inability of the kidneys to respond to ADH.On the ability of the kidneys to respond to ADH may affect drugs (drugs lithium), chronic diseases, including polycystic kidney disease, sickle cell anemia, renal failure, urolithiasis and heritable genetic damage.In cases where the cause of nephrogenic diabetes insipidus not discover exhibit diagnosis "idiopathic" nephrogenic diabetes insipidus.
sometimes to distinguish central from nephrogenic diabetes insipidus, require a trial of medication desmopressin.It would be ineffective in nephrogenic type.To determine the cause of this type of diabetes insipidus should be a thorough investigation of kidney function.For treatment
nephrogenic diabetes insipidus used diuretics (hydrochlorothiazide, amiloride), and, as an additional treatment, nonsteroidal anti-inflammatory drugs (indomethacin).So effectively moderate restriction of salt.
Dipsogenny diabetes insipidus
Dipsogenny diabetes insipidus is caused by a defect or damage to the thirst for the center, which is located in the hypothalamus.This defect leads to abnormal thirst and the consumption of large amounts of fluid.Because large amounts of fluid consumption ADH secretion is suppressed, and increases the amount of urine.Often, this type of diabetes insipidus combined with mental disorders.Desmopressin or other drugs should not be used for the treatment of diabetes insipidus dipsogennogo since they can reduce the amount of urine, but it can not affect the thirst and fluid intake.There may be a fluid overload - water intoxication and severe damage to the brain.Scientists have not yet found an effective treatment dipsogennogo diabetes insipidus.
Gestational diabetes insipidus
Gestational diabetes insipidus only occurs during pregnancy as a result of the fact that the placenta destroys enzymes ADH mother.Frequent urination occurs typically in the third trimester, postpartum passes without any treatment.ADH level is usually reduced.
Most cases of gestational diabetes insipidus can be treated with desmopressin.
endocrinologist Faizulin NM