When body secretes large amounts of severely diluted urine, the condition is called Diabetes insipidus (DI). The amount of urine excreted does not reduce even when the liquid intake is reduced. This condition happens when the kidney is not able to concentrate urine, and happens due to the deficiency of antidiuretic hormone (ADH), also called vasopressin.
There are four types of Diabetes insipidus, namely --
Central Diabetes insipidus happens when hypothalamus or pituitary is damaged due to a tumor, stroke, neurosurgery or some other causes (like hemochromatosis, sarcoidosis, histiocytosis, tuberculoma, syphilis or genetic disorders). When hypothalamus is damaged, the patient may fail to feel thirst at all. Nephrogenic Diabetes insipidus happens when the kidney fails to respond normally to ADH.
Usually this happens as a reaction to certain medications prescribed (like lithium citrate and amphotericin B) or due to diseases like polycystic kidney disease (PKD), sickle-cell disease, hypocalcaemia and hypocalcaemia. It can also be hereditary, with usually men being the sufferer. Dipsogenic DI is due to the damage to the thirst mechanism in hypothalamus.
As the person experiences abnormal thirst and fluid intake increases, the secretion of ADH is suppressed and urine output increases too. Gestational DI occurs only during pregnancy. During pregnancy, women produce vasopressin’s, which breaks down ADH. When this becomes extreme, Gestational DI is formed. Usually, administering desmopressin treats this.
Diabetes insipidus occurs when the body fails to produce enough antidiuretic hormone (ADH) or stops responding to ADH correctly. ADH helps in controlling the water balance in body by controlling the production of urine. Hypothalamus produces it while the pituitary gland stores it. When there is damage caused to either, the flow of ADH is hampered, thus resulting in the diabetes insipidus.
The person suffering from Diabetes insipidus will pass excessive amount of urine (up to or more than 3 liters every day). They are always feeling thirsty and thus are constantly drinking water. They will need to urinate in almost every 15 to 20 minutes. They will suffer from disturbed sleep and daytimes, due to frequent passing of urine.
Dehydration is the consequence of this disease and when it is left undiagnosed or treated, since it raises the sodium levels in the blood. This might, in turn, lead to tiredness, lethargy, confusion and even fits as well as coma. Blurred vision rarely happens. Amongst kids, Diabetes insipidus can affect the appetite, eating, weight gain and growth as well. Symptoms like fever, vomiting or diarrhea may also show.
You can run specific tests to check the diabetes insipidus. For example you can check the volume of the urine passed over 24 hours, amount of urine passed when the fluid intake is restricted, body response on administered with ADH etc. You can also do some scans to identify specific causes. You can also measure the blood electrolytes in order to check the level of sodium in blood. Urinalysis can also produce results showing the specific gravity of urine.
If there is a treatable cause for the Diabetes insipidus, it can be treated. Otherwise, a daily administering of ADH is the solution. Nephrogenic diabetes can be treated by following a low-sodium diet and proper medication like diuretic hydrochlorothiazide (HCT or HCTZ) or indomethacin.
At times, HCT and amiloride are combined to treat hypokalemia. Central diabetes insipidus and gestational diabetes insipidus respond to desmopressin, though, at times this might not be effective. While desmopressin may work for these two forms of Diabetes insipidus, it should not be administered for treating Dispogenic Diabetes insipidus or Nephrogenic Diabetes insipidus. Gestational Diabetes insipidus also has the tendency to abate itself after a period of 4 to 5 weeks.
Children suffering from diabetes insipidus may not be able to thrive as they are suffering from the disease. Meanwhile, if the patients take in sufficient amount of water and get proper treatment, they may be able to live normal lives.