Polyuria

In nephrogenic diabetes insipidus the kidney s ability to respond to AVP is impaired by different causes, such as drugs (e.g. lithium), chronic disorders (e.g. sickle cell disease, kidney failure) or inherited genetic disorders (X-linked or autosomal NDI). This type of diabetes insipidus can not be treated by exogenous administration of AVP or AVP analogues. Instead, diuretics (hydrochlorothiazide combined or not with amiloride) and NSAI (indomethacin) are administrated to ameliorate polyuria. 

Renal—hematuria, cystitis, elevated blood urea nitrogen, polyuria, dysuria, oliguria, and acute renal failure in those with impaired renal function... 

Lithium carbonate is rapidly absorbed after oral administration. The most common adverse reactions include tremors, nausea, vomiting, thirst, and polyuria Toxic reactions may be seen when serum lithium levels are greater than 1.5 mEq/L (Table 32-1). Because some of these toxic reactions are potentially serious, lithium blood levels are usually obtained during therapy, and the dosage of lithium is adjusted according to the results. 

Those with type 1 diabetes mellitus produce insulin in insufficient amounts and tiierefore must have insulin supplementation to survive Type 1 diabetes usually has a rapid onset, occurs before die age of 20 years, produces more severe symptoms tiian type 2 diabetes, and is more difficult to control. Major symptoms of type 1 diabetes include hyperglycemia, polydipsia (increased thirst), polyphagia (increased appetite), polyuria (increased urination), and weight loss. Treatment of type 1 diabetes is particularly difficult to control because of the lack of insulin production by die pancreas. Treatment requires a strict regimen tiiat typically includes a carefully calculated diet, planned physical activity, home glucose testing several times a day, and multiple daily insulin injections. 

Anorexia, nausea, vomiting, lethargy, bone tenderness or pain, polyuria, polydipsia, constipation, dehydration, muscle weakness and atrophy, stupor, coma, cardiac arrest... 

Contact the primary health care provider if the following occur nausea, vomiting, anorexia, constipation, abdominal pain, dry mouth, thirst, or polyuria (symptoms of hypercalcemia). 

Hypoperfusion of skeletal muscles leads to fatigue, weakness, and exercise intolerance. Decreased perfusion of the central nervous system (CNS) is related to confusion, hallucinations, insomnia, and lethargy. Peripheral vasoconstriction due to SNS activity causes pallor, cool extremities, and cyanosis of the digits. Tachycardia is also common in these patients and may reflect increased SNS activity. Patients will often exhibit polyuria and nocturia. Polyuria is a result of increased release of natriuretic peptides caused by volume overload. Nocturia occurs due to increased renal perfusion as a consequence of reduced SNS renal vasoconstrictive effects at night. In chronic severe HF, unintentional weight loss can occur which leads to a syndrome of cardiac cachexia. This results from several factors, including loss of appetite, malabsorption due to gastrointestinal edema, elevated metabolic rate, and elevated levels of proinflammatory cytokines. 

Patients with metabolic alkalosis rarely have symptoms attributable to alkalemia. Rather, complaints are usually related to volume depletion (muscle cramps, positional dizziness, and weakness) or to hypokalemia (muscle weakness, polyuria, and polydipsia). 

Adverse Effects The most common adverse effects are gastrointestinal upset, tremor, and polyuria,30 which are dose-related. Nausea, dyspepsia, and diarrhea can be minimized by coadministration with food, use of sustained-release formulations, and giving smaller doses more frequently to reduce the amount of drug in the gastrointestinal tract at a given time. Tremor is present in up to 50% of patients. In addition to the approaches above, low-dose P-blocker therapy such as propranolol 20 to 60 mg/day often reduces the tremor. 

Symptoms of diabetes plus a casual plasma glucose concentration greater than or equal to 200 mg/dL (11.1 mmol/L). Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss. 

I day for diagnosis unless unequivocal symptoms of hyperglycemia exist, such as polydipsia, polyuria, and polyphagia. The ADA recommends FPG determination as the principal tool for diagnosis of DM in non-pregnant adults owing to ease of use, acceptability to patients, and lower cost.7 While the OGTT is more sensitive and modestly more specific than FPG determination, it is difficult to reproduce the results and is rarely performed in practice today. 

Diuretics Thiazides diuretics, loop diuretics Produce polyuria... 

Diabetes insipidus (polyuria due to decreased antidiuretic hormone)... 

Ethanol Polyuria and frequency (via effects on ADH), functional Ul (delirium, sedation), urgency... 

Diabetes insipidus Polyuria due to the failure of renal tubules to reabsorb water in response to antidiuretic hormone. 

The answer is c. (Katzung, p 493.) Lithium treatment frequently causes polyuria and polydipsia. The collecting tubule of the kidney loses the capacity to conserve water via anti diuretic hormone. This results in significant free-water clearance, which is referred to as nephrogenic diabetes insipidus. 

A 55-year-old postmenopausal female develops weakness, polyuria, and polydipsia. Nephrocalcinosis is detected by a computed tomography (CT) scan. Her serum creatinine is elevated. Which of the following agents may have caused these adverse effects ... 

The answer is c. (Hardman, p 15.33.) Enthusiastic over medication with vitamin D may lead to a toxic syndrome called hy/jervitamijmsis D. The initial symptoms can include weakness, nausea, weight loss, anemia, and mild acidosis. As the excessive doses are continued, signs of nephrotoxicity are manifested, such as polyuria, polydipsia, azotemia, and eventually nephrocalcinosis. In adults, osteoporosis can occur. Also, there is CNS impairment, which can result in mental retardation and convulsions. 

Li+ also inhibits several hormone-stimulated adenylate cyclases which, in some cases, appear to be related to side effects of Li+ therapy. For instance, Li+ inhibits the hydro-osmotic action of vasopressin, the antidiuretic hormone which increases water resorption in the kidney [136]. This effect is associated with polyuria, a relatively harmless side effect sometimes experienced with Li+ treatment, which arises from the inability of the kidney to concentrate urine. Li+ has been shown to inhibit vasopressin-stimulated adenylate cyclase activity in renal epithelial cells. Additionally, Li+ is reported to enhance the vasopressin-induced synthesis of prostaglandin E2 (PGE2) in vitro in kidney. PGE2 inhibits adenylate cyclase activity by stimulation of Gj, and, therefore, this effect may contribute to the Li+-induced polyuria. 

Corticosteroids Hypertension, hyperglycemia, Blood pressure if available, polyuria. 

Patients with secondary hypertension may complain of symptoms suggestive of the underlying disorder. Patients with pheochromocytoma may have a history of paroxysmal headaches, sweating, tachycardia, palpitations, and orthostatic hypotension. In primary aldosteronism, hypokalemic symptoms of muscle cramps and weakness may be present. Patients with hypertension secondary to Cushing s syndrome may complain of weight gain, polyuria, edema, menstrual irregularities, recurrent acne, or muscular weakness. 

Between 20% and 40% of patients present with diabetic ketoacidosis after several days of polyuria, polydipsia, polyphagia, and weight loss. 

Lethargy, polyuria, nocturia, and polydipsia can be present on diagnosis significant weight loss is less common. 

Casual is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes indude polyuria,... 

Regardless of the insulin regimen chosen, gross adjustments in the total daily insulin dose can be made based on A1C measurements and symptoms such as polyuria, polydipsia, and weight gain or loss. Finer insulin adjustments can be determined on the basis of the results of frequent SMBG. 

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