Symptoms of Diabetes Insipidus

Symptoms of Diabetes Insipidus

Diabetes insipidus is a medical condition in which person produces large amounts of urine. The urine is much diluted and may vary from three-liters up to twenty-liters of urine in a day! Normally, kidneys absorb more than 90% of the filtered water. Diabetes insipidus occurs because kidney is not able to reabsorb the filtered water and excessive water is excreted in the form of urine. This inability to absorb water is due to problem with a hormone called Anti-Diuretic Hormone (ADH), which is also called, vasopressin. The ADH is either absent or it’s not functioning properly in patients with diabetes insipidus.

Antidiuretic hormone is produced by posterior pituitary gland, which is present in the brain. ADH is released into the blood and it acts on the kidneys directing it to absorb more and more water. The level of ADH depends upon the body’s fluid state. In well-hydrated sate, ADH secretion is low because body has enough water. In dehydrated state, ADH secretion is high because body wants kidney to absorb all the available water.

The diabetes insipidus should not be confused with the diabetes mellitus, which is a completely different disease. The diabetes mellitus is due to a deficiency of insulin hormone, which is important for the metabolism of the carbohydrates.

Symptoms of Diabetes Insipidus:

The symptoms of diabetes insipidus are as follows:

vasopressin

Increased Urination: Patients with diabetes insipidus produce large amounts of urine. The urine is diluted but otherwise normal. They may pass urine every hourly throughout day and night. The urine volume may range from 3-liters to massive 20-liters in a day! The medical term for increased urination is polyuria.

Extreme Thirst: Patients with diabetes insipidus are thirsty and drink a lot of water, especially icy water. This increased thirst and water-intake is secondary to the increased urination. The thirst is intense and uncontrollable. The patients with severe diabetes insipidus may drink up to 20 liters of fluids in a day to fill the water deficit of the body and maintain fluid balance.

Nocturia: Nocturia is a medical term for increased urination at night-time. People have to wake up multiple times at night to pass urine. This causes significant distress, sleep problems, fatigue and day time somnolence. The lack of good sleep impairs the quality of life.

Dehydration: Patients with diabetes insipidus often maintain water balance by taking enough water but they can be dehydrated if they do not have access to free water for prolonged time such as in times of travel. These persons develop dry mouth, dry skin, rapid heart rate and decreased blood pressure. The symptoms progressively worsen with time if fluids are continuously unavailable as kidneys continue to excrete large amounts of urine even in dehydrated persons.

Confusion, Drowsiness and Altered Consciousness: The persons may develop confusion and drowsiness if they are continually dehydrated. The loss of large amounts of water in urine without fluid-replacement causes electrolyte disturbances, especially sodium concentrations in the blood. The symptoms may progress from mild confusion to drowsiness, and then rarely to altered consciousness and coma, depending upon the changes in the level of electrolyte concentrations.

Bed-wetting: The children suffering from diabetes insipidus may present with bed-wetting especially those children who were previously toilet-trained. This bed-wetting may be distressful for both parents and the child, and should not be neglected.

Inconsolable Crying: The infants and small children may present with the irritability, fussiness and inconsolable crying. These infants usually either breast-fed actively because of mild dehydration or they become lethargic with decreased body muscle tone in severe dehydration and do not take breast-fed at all. They may also have frequent bouts of vomiting and diarrhea exacerbating the already dehydrated state.

Weight loss: The patients with diabetes insipidus may report weight loss, which is often transient and due to excessive fluid-loss. The weight is regained with adequate fluid ingestion.

Fever: The loss of body water disturbs the body-cooling system. Our body produces sweat in hot weather and cools down our body by the process of evaporation. The loss of body fluids impairs sweat production rising the body temperatures causing fever.

Other symptoms: Some of the other symptoms of diabetes insipidus are muscle cramps, loss of appetite, nausea, and growth restriction in children.

If you have the above-mentioned symptoms, you must consult you healthcare provider for appropriate diagnosis and management.

If you are diagnosed with diabetes insipidus, you should drink enough fluids and make sure to have access to water and fluids when planning to travel because dehydration may cause electrolyte imbalance and worsening of the symptoms.

References:

  • McPhee S.J., Papadakis M.A. Current Medical Diagnosis and Treatment 2016. Lange McGraw Hill. pp 1092-1093.
  • Taal, M.W., Chertow, G.M., Marsden, P.A., et al., eds. 2011. Brenner and Rector’s The Kidney. 9th ed. Philadelphia: Elsevier Saunders: chapter 15.
  • Khardori, M. Diabetes Insipidus Clinical Presentation. Retrieved from: http://emedicine.medscape.com/article/117648-clinical Date assessed: 28th April, 2016.
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