Water diabetes

Also known as water diabetes, diabetes insipidus (DI) is a rare chronic disease that causes excessive urination. If not properly treated, it can result in electrolyte imbalance and dehydration. It may be caused by a number of factors, including lithium use (a psychiatric drug used for bipolar disorder), neurological disease, or an inadequate amount of ADH (anti-diuretic hormone, or vasopressin, which is produced by the pituitary gland). DI caused by insufficient ADH is called central diabetes insipidus. 

Hydrocortisone and Prednisolone. Following the discovery of the antiinflammatory actions of cortisone (1) and cortisol (2), there was a need not only to develop highly efficient routes to the corticoids, but to discover novel stmctures with fewer side effects than those of the corticoids, eg, sodium and water retention, reduced carbohydrate tolerance (steroid diabetes), osteoporosis, and depressed host defense. 

Metformin. Metformin [657-24-9] (1,1-dimethylbiguanide), mol wt 129.17, forms crystals from propanol, mp 218—220°C, and is soluble in water and 95% ethanol, but practically insoluble in ether and chloroform. Metformin, an investigational dmg in the United States, does not increase basal or meal-stimulated insulin secretion. It lowers blood glucose levels in hyperglycemic patients with Type II diabetes but has no effect on blood glucose levels in normal subjects. It does not cause hypoglycemia. Successful metformin therapy usually is associated with no or some weight loss. 

Paradoxically, the thia2ides are efficacious, especially if combined with a prostaglandin synthetase inhibitor such as indomethacin or aspirin, in the treatment of nephrogenic diabetes insidipus, in which the patient s renal tubules fail to reabsorb water despite the excessive production of ADH (28). Thia2ides can decrease the urine volume up to 50% in these patients. 

Robben JH, Knoers NV, Deen PM (2006) Cell biological aspects of the vasopressin 1ype-2 receptor and aquaporin 2 water channel in nephrogenic diabetes insipidus. Am J Physiol Renal Physiol 291 F257-F270... 

X-linked nephrogenic diabetes insipidus (NDI) is caused by mutations in the gene for the vasopressin V2 receptor leading to an insensitivity of the kidney for the antidiuretic hormone arginine vasopressin (AVP). The main symptom of the disease is diuresis, i.e., the production of a large amount of diluted urine. Due to the massive loss of water, the patients suffer from thirst and are in danger of dehydration. The disease usually becomes evident shortly after birth. 

Relieve dry mouth by sucking on hard candy (unless die patient has diabetes) or frequent sips of water. Consult a dentist if dryness of die moudi interferes widi wearing, inserting, or removing dentures or causes other dental problems. 

Water replacement as dextrose 5% in water ° Central diabetes insipidus... 

TBW depletion (often referred to as dehydration ) is typically a more gradual, chronic problem compared to ECF depletion. Because TBW depletion represents a loss of hypotonic fluid (proportionally more water is lost than sodium) from all body compartments, a primary disturbance of osmolality is usually seen. The signs and symptoms of TBW depletion include CNS disturbances (mental status changes, seizures, and coma), excessive thirst, dry mucous membranes, decreased skin turgor, elevated serum sodium, increased plasma osmolality, concentrated urine, and acute weight loss. Common causes of TBW depletion include insufficient oral intake, excessive insensible losses, diabetes insipidus, excessive osmotic diuresis, and impaired renal concentrating mechanisms. Long-term care residents are frequently admitted to the acute care hospital with TBW depletion secondary to lack of adequate oral intake, often with concurrent excessive insensible losses. 

The ADA does not recommend low-carbohydrate diets in diabetes management. Although carbohydrates are a primary contributor to post-meal glucose levels, they are also an important source of energy, water-soluble vitamins, minerals, and fiber. Thus, the ADA recommends that carbohydrate intake consists of 45% to 65% of total calories. 

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. 

Hypernatremia can result from water loss (e.g., diabetes insipidus [DI]) hypotonic fluid loss or, less commonly, hypertonic fluid administration or sodium ingestion. 

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