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1. DIABETES INSIPIDUS Mr Yogendra Mehta Lecturer, HOD(AHD) BRNC

2. Definition Diabetes insipidus is a disorder of the posterior lobe of the pituitary gland characterized by a deficiency of antidiuretic hormone (ADH ), or vasopressin. Great thirst ( polydipsia ) and large volumes of dilute urine characterize the disorder.

3. Types of DI Central diabetes insipidus B) Nephrogenic diabetes insipidus

4. Causes A) Central diabetes insipidus :- Head trauma or surgery Pituitary or hypothalamic tumor Intracerebral occlusion or infection

5. B) Nephrogenic diabetes insipidus Systemic diseases involving the kidney Multiple myeloma sickle cell anemia Polycystic kidney disease Pyelonephritis Medications such as lithium

6. Pathophysiology A) Central diabetes insipidus :- Loss of vasopressin-producing cells , Causing deficiency in antidiuretic hormone ( ADH) synthesis or release; Deficiency in ADH, resulting in an inability to conserve water, leading to extreme polyuria and polydipsia

7. B) Nephrogenic diabetes insipidus Depression of aldosterone release or inability of the nephrons to respond to ADH , causing extreme polyuria and polydipsia

8. Pathophysiology Due to etiological factor Deficiency of ADH Permeability of water is diminished Excretion of Large volumes of hypotonic fluid

9. Cont…. Note: Normally ADH increases kidneys permeability to water to promote water reabsorption and decrease urine output. ADH is normally released in response to increase serum osmolality and decrease Extracellular volume.

10. Signs and symptoms Polyuria with urine output of 5 to 15 L daily Polydipsia , especially a desire for cold fluids Marked dehydration, as evidenced by dry mucous membranes, dry skin, and weight loss Anorexia and epigastric fullness Nocturia and related fatigue from interrupted sleep

11. Diagnostic evaluation History collection Physical Examination Water deprivation test Hyper-tonic Saline test Urine output Serum Na+ level Plasma and Serum Osmolality 8 hour water deprivation test: deprived fluids for 8hrs or until 5% loss of body mass then weight patient hourly, plasma osmolality 4hrly urine volume and osmolarity 2hrly.

12. Diagnostic test results High serum osmolality , usually above 300 mOsm /kg of water Low urine osmolarity , usually 50 to 200 mOsm /kg of water; low urine- specifi c gravity of less than 1.005 Increased creatinine and blood urea nitrogen (BUN) levels resulting from dehydration Positive response to water deprivation test: Urine output decreases and specific gravity increases

13. Goals of management The objectives of therapy are to replace ADH (which is usually a long-term therapeutic program), to ensure adequate fluid replacement, and to identify and correct the underlying cause

14. Medical management Administration of ADH or its derivative: a) Vasopressin ( Pitressin ) - IM, Effective for 24 to72hrs. - Vial should be warmed and shaken vigorously before administrating to mix active component settles at bottom of vial. b) Lypressin ( Diapid nasal Spray) - Absorbed through nasal mucosa - Duration of action 4 to 6 hrs - may cause chronic nasal irritation.

15. Cont…. c) Desmo-pressin acetate. - Vasopressin deratives administered into the nose through a soft, flexible nasal. - Duration of action 12 to 24 hrs - For patient who have some residual hypothalamic ADH. d) Chloropropamide : - Potenciate action of reducing polyuria . e) Hydro – Chlorothiacin : - Reduce the urine volume - Dose 20 – 75 mg /kg/day

16. Surgical management 1.) Hypophysectomy :- - Removal of pituitary gland may be performed for the treatment of primary tumor of the pituitary gland.

17. complication Electrolyte imbalance Hypotension Hypovolemia Shock Death