Diabetes insipidus, symptoms and treatment

Update: February 2019

Diabetes is a medical term describing a condition.
organism, in which there is increased urination.
Despite the fact that there are two similar in name species
заболеваний —  сахарный и несахарный диабет, это две
completely different diseases, but the symptoms overlap. Their
combine only some similar symptoms, but diseases
caused by completely different disorders in the body.

Causes of diabetes insipidus

Diabetes insipidus is a disease caused by deficiency
vasopressin, its relative or absolute deficiency.
Antidiuretic hormone (vasopressin) is produced in
the hypothalamus and, among other functions in the body, is responsible for
normalization of urination. According to etiological signs distinguish
three types of diabetes insipidus: idiopathic, acquired and
genetic.

У большинства больных этим редким заболеванием причина  до
still remains unknown. Such diabetes is called –
idiopathic, they suffer up to 70 percent of patients.

Genetic is a hereditary factor. In this case
diabetes insipidus is sometimes manifested in several family members and in
generations in a row.

Medicine explains this by major changes in the genotype, 
contributing to the occurrence of disruptions in the antidiuretic
hormone. Hereditary predisposition of this disease
due to a congenital defect in the structure of the intermediate and
midbrain.

Considering the causes of diabetes insipidus should
take into account the mechanisms of its development:

Central diabetes insipidus – develops with insufficient
vasopressin production in the hypothalamus or a violation of its release
from the pituitary to the blood, suggest that the causes are:

  • Pathology of the hypothalamus, since it is responsible for the regulation
    urine excretion and synthesis of antidiuretic hormone, then violations
    his work leads to this disease. Causes and provoking
    factors that cause hypothalamic dysfunction
    to be acute or chronic infectious diseases: angina,
    flu, sexually transmitted diseases, tuberculosis.
  • Traumatic brain injury, concussion.
  • Brain surgery, inflammatory
    brain diseases.
  • Vascular lesions of the hypothalamic-pituitary system, which
    lead to circulatory disorders in the arteries of the brain that feed
    pituitary and hypothalamus.
  • Tumor processes of the pituitary and hypothalamus.
  • Cystic, inflammatory, degenerative kidney damage,
    violating the perception of vasopressin.
  • Autoimmune diseases
  • Also hypertension is one of the aggravating factors
    complicating the course of diabetes insipidus.

Renal diabetes insipidus – while vasopressin is produced
in normal amounts, but the kidney tissue does not respond to it
in due measure. The reasons may be as follows:

  • Sickle cell anemia is a rare disease
  • Congenital pathology is a hereditary factor
  • Damage to the brain substance of the kidney or urinary tubules
    nephron
  • polycystic (multiple cysts) or amyloidosis (deposition in
    amyloid tissue) kidney
  • chronic renal failure
  • increased potassium or decreased calcium in the blood
  • medication that acts on the fabric
    kidney toxic (for example, Lithium, Amphotericin B,
    Demeklotsilin)
  • sometimes occurs in debilitated patients or in elderly
    age

Sometimes stress can cause increased thirst.
(psychogenic polydipsia). Or diabetes insipidus on the background
pregnancy that develops in the 3rd trimester due to
destruction of vasopressin by enzymes produced by the placenta. AND
both kinds of violations are self-liquidated after
eliminate root causes.

Signs of diabetes insipidus

The disease occurs equally in both men and women, in
любом age, чаще всего в age 20-40 лет. Expressiveness
The symptoms of this disease depend on the degree of vasopressin deficiency.
With a slight lack of hormone clinical symptoms
can be erased, not pronounced. ANDногда первые симптомы
diabetes mellitus appear in people who have been in conditions
питьевого дефицита  — в путешествиях, походах, экспедициях, а
also when taking corticosteroids.

When a person begins to have such diabetes, its symptoms are not difficult.
notice, because the volume of daily urine increases significantly. it
polyuria, which in this disease may be different
intensity. Usually colorless urine, without salts and other
items. When this dehydration occurs, the body
requires fluid replenishment.

Respectively characteristic of diabetes insipidus symptom
is the feeling of unquenchable thirst or polydipsia. Frequent urges to
urination is forced by a person suffering from such diabetes,
drink a lot of water and other liquids. how
The result is a significant increase in urinary size.
the bubble. Symptoms of the disease are of great concern.
to the person, therefore, sick people usually immediately turn to
to the doctor.  Patients concerned about:

Несахарный диабет

Constant thirst – one of the symptoms of non-sugar
diabetes

  • frequent and abundant urination up to 4-30 liters per day
  • bladder size increase
  • strong thirst, disturbing even at night
  • insomnia or sleepiness
  • decrease sweating
  • low blood pressure
  • dramatic weight loss or vice versa obesity
  • lack of appetite
  • disorders of the gastrointestinal tract
  • increased fatigue
  • irritability
  • muscle pain
  • emotional imbalance
  • dry skin and mucous membranes
  • reduced potency in men
  • menstrual disorders in women
  • stretching and lowering of the stomach
  • dehydration

There is congenital diabetes insipidus when in children
manifestations are very pronounced, even neurological
disturbances, fever, vomiting. In the period of ripening
adolescents may be lagging in physical development.

If the patient is restricting fluid intake, then
dehydration symptoms appear as the kidneys don’t care
continue to remove large amounts of urine from the body. Then
vomiting, tachycardia, high body temperature may also occur,
headache, mental disorders.

Лечение несахарного diabetes

Before prescribing treatment, it is necessary to clarify the diagnosis,
установить природу, форму diabetes и выяснить причину появления
polyuria (increased urination) and polydipsia (thirst). For this
the patient is prescribed a comprehensive examination, including:

  1. Urinalysis with determination of density, sugar content
  2. To determine the daily amount of urine and specific gravity
    (low with diabetes insipidus) conduct a test Zimnitsky
  3. The level of plasma antidiuretic hormone can be determined.
    крови (< 0,6 нг на литр)
  4. For the differential diagnosis – test with dry milk.
    Evaluation criteria for this sample are: the amount of urine released;
    its relative density; body weight of the patient; his total
    state of health; blood pressure level; pulse rate. If a
    when conducting this sample, the amount of urine released
    decreases, its proportion increases, blood pressure,
    patient’s pulse and body weight remain stable, the patient feels
    satisfactory, not marking the emergence of new unpleasant for
    of his symptoms, the diagnosis of diabetes insipidus is refuted.
  5. X-ray of the skull
  6. MRI of the brain

If a основой развития несахарного diabetes служит опухоль, то
X-ray therapy or surgical treatment is performed. If a
the tumor cause is excluded, treatment should be carried out in two
directions: it is necessary to eliminate the pathological process in
hypothalamic-pituitary region, as well as to restore
water exchange in the body.

Patients with severe polyuria, when the daily volume of urine
makes over 4 liters, the specific antidiuretic is shown
therapy. Since prolonged severe polyuria in children leads to
growth retardation in adults to atony and expansion of the urinary
the bubble.

Now widely used to compensate for the central
несахарного diabetes получили препараты Десмопрессина. is he
produced in 2 forms: drops for intranasal administration –
Адиуретин и таблетированная форма
Минирин.

Для лечения нефрогенного несахарного diabetes наиболее эффективно
combine potassium-sparing diuretics –
Спиронолактон, тиазидные —
Гидрохлоротиазид,  комбинированные диуретики
ANDзобар, Амилоретик, Триампур композитум . With
treatment should limit salt intake to 2 g / day. With
central diabetes mellitus can also be used thiazide
diuretics.

However, if a patient has dippsogenic diabetes insipidus, treatment
Neither desmopressin nor thiazide diuretics is permissible.
Because they can cause water intoxication in severe form.
Their применение снижает экскрецию воды, при этом не уменьшая ее
consumption. With данном типе несахарного diabetes основное лечение
aims to reduce water intake and diet
restriction of protein food, salt, increase in consumption of dairy
products, fruits, vegetables.

It is dangerous to self-medicate with such a serious diagnosis.
Only a qualified doctor can select the appropriate treatment.
несахарного diabetes для конкретного больного.

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