Clinical approach to a patient complaining of polyuria

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1. Clinical approach-polyuria

2. polyuria >3L/d Differentiate fm inc frequency Collect 24hr urine

3. causes Physiological Excessive intake of fluid Cold climate Anxiety Pro rich diet Pathological Endocrine Renal Systemic Psychiatric Drugs Iatrogenic

4. Endocrine- DM, Central DI, Hyperparathyroidism, cushing’s & conn’s syndrome Renal-CRF(early),ATN(diuretic phase), pyelonephritis,nephrogenic DI Systemic- amyloidosis,sickle cell anemia

5. 5. Drugs- diuretics,Li,anticholinergics 6. Iatrogenic-excessive IVF, mannitol infusion,radiocontrast media 4. Psychiatric-schizophrenia

6. >3L/d <250 mosmol solutes/d Water diuresis Polydipsia DI WATER DEPRIVATION TEST , ADH SENSITIVITY >300 mosmol solutes/d Solute/osmotic diuresis Glucose[DM ] Mannitol Urea[pro ] Na +[diuretics] Ca2+ [ hyperparathyroid ]

7. History 1.Gen data 2.PC- polyuria 3.HOPC- # ass with fatigue,wt loss » DM # ass with depression » prim.Hyperparathy. # ass with bone pain » multiple myeloma # oliguria first » ATN

8. 4.Past History- #h/o transurethral resection of prostate » post obstructive diuresis #h/o neurosurgery » central DI 5.Personal History- Diet-protein Appetite-DM Addiction-caffeine

9. 6.Family History- DM, PKD, Sickle cell anemia 7.Treatment History- diuretics,Li, anticholinergics 8.Allergic History 9.SES 10.Menstrual history

10. Gen examination Poorly built & nourished- DM Coma- natriuresis Not oriented- schizophrenia Pallor- sickle cell anemia, CRF Edema- RF

11. Pulse high vol- DM, Sickle cell anemia, pyelonephritis low vol- electrolyte imbalance BP high- DM, PKD, Conn’s low- DI

12. Febrile- pyelonephritis Tachypnoea- DM,Bartter’s syndrome

13. GIT examination inspection- dry oral cavity- sjogren’s syndrome, anticholinergics palpation- pain- pyelonephritis; mass- PKD

14. Percussion- dull note- PKD Auscultation- bruits- RF

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