Browse
Topics & Collections
Search for a specific
disease or term
—  or  —
Learn more about ACP Smart Medicine

Dynamed

X
This content was provided by DynaMed (dynamed.ebscohost.com). For more information click here.
Last Updated: 1/29/2013  

Diabetes Insipidus

  • Measure urinary output from patients after neurosurgery or head trauma to anticipate the development of central DI.

  • Obtain diagnostic testing for DI in suspected cases.

    • o Measure 24-hour urinary volume and urinary osmolality to evaluate for dilute polyuria.

    • o Perform a water deprivation test to determine the type (pituitary vs. nephrogenic vs. psychogenic polydipsia) if the diagnosis of DI has been confirmed by demonstration of dilute polyuria. Concentrated urine after water deprivation indicates psychogenic polydipsia.

    • o If the urine does not concentrate with water deprivation, perform desmopressin challenge to assess renal AVP sensitivity and distinguish nephrogenic from central DI. In central DI, urine osmolality with increase and urine volume will decrease in response to desmopressin.

    • o Check blood glucose to rule out diabetes.

    • o Perform further testing depending on the results, including MRI of the brain in patients with central DI and renal ultrasound in patients with nephrogenic DI.

  • Consult an endocrinologist to assist in the diagnostic evaluation of polyuria and the management of patients with DI; consult other subspecialists as needed.

  • Ensure access to free water in patients with partial central or nephrogenic DI and intact thirst, and replace free water judiciously in other settings.

  • Use desmopressin in the outpatient setting to manage chronic central DI in patients who have intact thirst.

  • Ensure that patients understand the significance of thirst, access to water, urinary output, and proper use of medications.

DOI: 10.7326/d145
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Saraswati Kache, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Robert J. Ferry, Jr., MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Robert J. Ferry, Jr., MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Related Content
Annals of Internal Medicine