Diabetes Insipidus

WHAT YOU SHOULD KNOW:

• Diabetes insipidus (DI) is a disease where you cannot concentrate your urine. With DI, you urinate large amounts of dilute (watered down) urine. The amount of urine you make is controlled by chemicals in your body called hormones. Antidiuretic hormone (ADH), or L-arginine vasopressin (AVP), is made to decrease the amount of water lost in your urine. ADH is made in an area of your brain called the hypothalamus. When you have DI, your body does not make, or respond to ADH the way it should. You may have central diabetes insipidus (CDI) if your body has trouble making and releasing ADH. Nephrogenic diabetes insipidus (NDI) occurs when your kidneys do not respond to normal levels of ADH in your body. DI may be a short term illness, or you may have it for the rest of your life.
  
  
• With DI, your body will not hold on to needed water, and you may become very ill. When your body loses too much water, you become dehydrated. You may feel very thirsty and have dry skin, headaches, and vision changes. Severe dehydration can lead to damage to your organs, such as your kidneys. You may need to have blood and urine tests, and a water deprivation test to diagnose your DI. You also may need a magnetic resonance imaging (MRI) test to check your brain for problems. Treatment includes replacing lost fluids, medicines, and diet changes. Treatment may help your body make and use ADH properly. Treatment may help prevent illness and organ damage from losing large amounts of body fluid. Treatment may save your life.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• You may have an allergic response to the medicines used for your treatment. You may get a skin rash, have a pounding heartbeat, or trouble breathing. If more fluid is replaced than your body can handle, you may have swelling in your brain. Even with treatment, you may be at a higher risk for a blockage in your kidneys or bladder. Your kidneys may begin to stretch from a blockage and lead to kidney failure.
  
  
• If your DI is not treated, your symptoms may worsen. Urinating large amounts may cause you to become dehydrated. Dehydration can lead to weakness, confusion, headaches, and vision changes. You also may have seizures (convulsions), brain swelling, and you may go into a coma. If you choose not to treat your DI, your kidneys and other organs may fail, and you may die. Ask your caregiver about any questions you may have about DI, your treatment, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Intake and output:

Your caregivers will need to know the amount of liquid you are getting. They also will need to know how much you are urinating. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Make sure you tell your caregiver when you are feeling thirsty. Ask caregivers if they need to measure or collect your urine before you dispose of it.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

Weight:

You may be weighed each day. Caregivers will compare your weight from day to day. This helps caregivers see how much body fluid you have.

Medicines:

The medicines you may need will depend on the type of DI that you have:

• Medicine to treat CDI:
  
  
  • ADH replacement: You may be given medicines that increase the amount of ADH your body makes. The medicines help your body use the ADH to decrease your thirst and the amount you urinate.
    
    
  
  
• Medicines to treat NDI:
  
  
  • Thiazide diuretics: These medicines may help your kidneys use ADH properly. The medicine also helps you urinate less and decrease the amount of fluid you lose with urination.
    
    
  • Potassium-sparing diuretics: This medicine helps your kidneys use ADH properly. The medicine helps decrease the amount of fluid you lose with urination and keep a normal potassium level.
    
    
  • Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. NSAIDs may help increase the water held in your kidneys and decrease your urine output. This medicine can cause stomach or kidney problems in certain people. Ask your caregiver if you have any questions about NSAIDs.
    
    
  • Prostaglandin synthetase inhibitors: These medicines work to decrease how much you are urinating.

Tests:

Certain tests may help your caregiver learn what type of DI you have. Testing also may help plan your treatment. You may need one or more of the following:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Urine sample: Caregivers will check your urine often to see how dilute it is.
  
  
• Water deprivation test: This test is done to check for a lack of ADH in your body. The test also may tell caregivers if you have CDI or NDI. You may not be allowed to drink liquids for 2 to 12 hours before the test. You may be asked not to eat. During the test, you will need to give a urine sample, and check your weight every hour. You also may need have a blood sample taken every two hours. When caregivers see that you are losing weight and your urine is dilute, they will give you a shot of medicine. The medicine may be ADH or another medicine that acts like ADH. Caregivers will take another blood and urine sample about one hour after you get the medicine.
  
  
• Hypertonic saline infusion test: For this test, caregivers will give you a special liquid through an IV. You will not be able to drink any liquids during this test. During the test, caregivers will take blood samples from you about every 30 minutes. The blood is then sent to the lab to check your level of ADH.

Treatment options:

The goal of treatment is to decrease your urine output. The fluids in your body that have been lost through urination will need to be replaced. You may need IV fluids depending on how much water you have lost. If you have NDI caused by a medicine, your caregiver may have you stop taking that medicine. If your NDI is caused by a disease, your caregiver will work with you to treat that disease.

Low-salt diet:

If you are able to eat, you may need to be on a low-salt diet. A low-salt diet may help decrease the amount of water you lose from your body.

Ventilator:

If your DI has caused problems with your breathing, you may need a ventilator. A ventilator is a special machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal tube (ET tube) in your mouth or nose. The ET tube is hooked to the ventilator, and can also give extra oxygen to you.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Diabetes Insipidus (Inpatient Care)