Thursday, April 27, 2017

DIABETES INSIPIDUS - Symptoms, causes and treats

Understanding Diabetes Insipidus

DIABETES INSIPIDUS - Symptoms, causes and treats - Diabetes insipidus is a fairly rare condition, with symptoms always feeling thirsty and at the same time frequent urination in large amounts. If very severe, the sufferer can urinate as much as 20 liters a day.

Diabetes insipidus itself is different from diabetes mellitus. Diabetes mellitus is a long-term disease characterized by blood sugar levels above normal. Diabetes insipidus, on the other hand is not associated with blood sugar levels.

Causes of Diabetes Insipidus

The occurrence of diabetes insipidus due to disruption of antidiuretic hormone (ADH) that regulates the amount of fluid in the body. This hormone is produced hypothalamus, a special tissue in the brain. This hormone is stored by the pituitary gland after it is produced by the hypothalamus.
The pituitary gland will secrete this antidiuretic hormone when the water content in the body is too low. 'Antidiuretic' means contrary to 'diuresis'. 'Diuresis' itself means the production of urine. This antidiuretic hormone helps maintain water in the body by reducing the amount of fluid wasted through the kidney in the form of urine.
The cause of diabetes insipidus is the production of decreased antidiuretic hormones or when the kidneys are no longer responding as usual to antidiuretic hormones. As a result, the kidneys secrete too much fluid and can not produce dense urine. People who experience this condition will always feel thirsty and drink more for trying to compensate for the amount of fluid lost.
Diabetes insipidus itself is divided into two main types, namely:
  • diabetes insipidus cranial. This type of diabetes insipidus is the most common. Because the body does not have enough antidiuretic hormones from the hypothalamus. This condition can be caused by damage to the hypothalamus or to the pituitary gland. The damage that occurs can be caused by the occurrence of infection, surgery, brain injury, or brain tumors.
  • D nephrogenic diabetic insipidus . This type of diabetes insipidus arises when the body has enough antidiuretic hormone to regulate the production of urine, but the kidney organ does not respond to it. This condition may be caused by impaired renal organ function or as a condition of heredity. Some drugs used to treat mental illness, such as lithium, can also cause this type of diabetes insipidus.
If you experience symptoms of diabetes insipidus, such as always feel thirsty and urinate more than usual, you should see a doctor immediately. Maybe you are not diabetes insipidus, but it would be better to know the cause.
Adults urinate as much as 4-7 times a day, while small children do up to 10 times a day. This is because the bladder of children is smaller. The doctor will perform several tests to determine the exact cause and diagnosis of the condition experienced.

Treatment of Diabetes Insipidus

In cranial diabetes insipidus, treatment may not be necessary in mild cases. To compensate for the amount of liquid wasted, you need to consume more water. There is a drug that serves to mimic the role of an antidiuretic hormone called desmopressin. If necessary, you can take this medicine.
While in diabetes insipidus nephrogenic, the drug used to overcome it is thiazide diuretic. This drug serves to reduce the amount of urine produced by the kidney organs.

Complications of Diabetes Insipidus

The low amount of water or fluid in the body is called dehydration. This is one of the complications caused by diabetes insipidus. If the dehydration is mild enough, you can drink oralit to overcome it. But treatment at the hospital will be necessary if the dehydration is severe enough.

Symptoms Of Diabetes Insipidus

The main symptoms of diabetes insipidus are always feeling thirsty and frequent urination in large quantities. You will always be haunted by thirst despite drinking a lot of water.

The amount of urine expressed by people with diabetes insipidus each day is about 3-20 liters, ranging from cases of mild diabetes insipidus to the most severe cases. Urine experienced by patients this condition can be as much as 3-4 times per hour.

Symptoms that appear above can interfere with your daily activities and sleep patterns. As a result will appear tired, irritable, and difficult to concentrate in performing daily activities.
Diabetes insipidus in children may be more difficult to recognize, let alone the child has not been able to communicate well. Symptoms in children suffering from diabetes insipidus are:
  • Bedwetting at bedtime.
  • Easily disturbed or angry.
  • Crying excessively.
  • High body temperature or hyperthermia.
  • Weight loss for no apparent reason.
  • Loss of appetite.
  • Feeling tired and exhausted.
  • Slower growth.
Be sure to see your doctor immediately if you have two main symptoms of diabetes insipidus, always feel thirsty and frequent urination in large quantities.

Causes Of Diabetes Insipidus

The hypothalamus, the tissue in the brain that controls mood and appetite, is the organ that produces antidiuretic hormones. This hormone will be stored in the pituitary gland until needed. The pituitary gland itself is under the brain and is behind the bridge of the nose. This gland will release antidiuretic hormone when the body's water content decreases to stop the production of urine in the kidney.

Diabetes insipidus occurs when the antidiuretic hormone is impaired in regulating the body's water content. As a result, the body produces a lot of urine and dispose of water in very large quantities.
The following is a further explanation of both types of diabetes insipidus.
Cranial Diabetic Insipidus
This is a condition when the body does not produce enough antidiuretic hormones and results in the amount of water wasted in the urine. Below are some of the most common causes of this type of diabetes insipidus, namely:
  • About 16 percent of cases of cranial diabetes insipidus are caused by severe head injuries that damage the hypothalamus or pituitary gland.
  • About 20 percent of cases of cranial diabetes insipidus are caused due to complications from brain surgery that damage the hypothalamus or pituitary gland.
  • About 25 percent of cases of cranial diabetes insipidus are caused by brain tumors that damage the hypothalamus or pituitary gland.
Here are some of the less common causes of diabetes insipidus.
  • Brain cancer.
  • Lack of oxygen in the brain for example due to stroke.
  • The occurrence of infections that damage the brain, such as encephalitis and meningitis.
  • Wolfram syndrome is a rare genetic disorder that can cause loss of sight.
About 1 in 3 cases of cranial diabetes insipidus are not known.
Nephrogenic Diabetic Insipidus
This is the condition when the antidiuretic hormone is produced according to the level required by the body. But the kidney organ is not sensitive or does not respond to this hormone.
The antidiuretic hormone normally sends signals to the tissues of the nephrons located in the kidneys. Nephrons are small structures that control how much water is absorbed by the body and how much water is expelled in the form of urine. For people suffering from diabetes insipidus nephrogenic, the process of sending this signal is disrupted. As a result, people who experience it will always feel thirsty because urine is wasted in large quantities. Diabetes insipidus nefrogenik itself is divided into two types:
  • Congenital nephrogenic diabetes insipidus or known as congenital nephrogenic diabetes insipidus. Congenital diabetic nephrogenic patients are born with this condition. There are two types of mutations or genetic changes that cause congenital nephrogenic diabetes insipidus, namely AVPR2 and AQP2. AVPR2 genetic mutations can only be transmitted from mother to son. This type of mutation occurs in 9 of 10 patients. While genetic mutations of AQP2 occur in 1 in 10 cases of congenital nephrogenic diabetes insipidus and may affect both men and women.
  • Acquired nephrogenic diabetes insipidus. This type of diabetes insipidus is not born with this condition. The most common cause of acquired nephrogenic diabetes insipidus is lithium side effects. Lithium itself is a drug used to treat bipolar disorder. If taken in the long term, the kidney organ cells can be damaged and then no longer able to respond to antidiuretic hormones. Nearly 50 percent of people will develop niprogenic diabetes insipidus if taking this drug in the long run. Be sure to perform kidney organ examinations once every three months as long as you consume lithium. Other causes of this condition other than lithium are:
    • Pyelonephritis or kidney infection. Kidney organs are damaged by infection.
    • Urinary tract obstruction. The inhibition of one or both urinary tracts that connect the kidney to the bladder, such as kidney stones.
    • Hyperkalemia . An excess amount of calcium in the blood can damage the kidneys.
    • Hypokalemia. The amount of potassium in the blood is small when all the cells in the body need potassium to function properly.
    • Diagnosis Of Diabetes Insipidus

Diabetes insipidus has symptoms similar to type 1 diabetes and type 2 diabetes, such as thirst and frequent urination. Your doctor will inquire about the symptoms you are experiencing and may do some tests to make sure you are suffering from which conditions.
Referrals to a specialist hormonal disorder may be given to performing these tests:

  • Water deprivation test. In this test, you are required to not consume fluids for several hours to see your body's reaction. If your condition is normal, you will only urinate a little and with a concentration that is more concentrated. But if you have diabetes insipidus, you will waste a lot of water.
  • Blood tests and urine tests. Blood tests performed to determine levels of antidiuretic hormone in the blood. In addition to blood, urine examination will also be performed to find out some other elements, such as glucose, calcium, and potassium. Urine of diabetics insipid will be very dilute. If the glucose level is high, then what is suffered is type 1 diabetes or type 2 diabetes.
  • An antidiuretic hormone test. This test will show your body's reaction to the antidiuretic hormone given by injection to find out what type of diabetes insipidus is suffered. This procedure is performed after a water deprivation test, if the given hormone helps you stop producing urine, then you have cranial diabetes insipidus due to lack of antidiuretic hormone. But if you keep producing lots of urine, then you have kidney disorders or diabetes insipidus nefrogenik.
  • MRI . If a hormonal disease specialist suspects you have cranial diabetes insipidus because of damage to the hypothalamus or pituitary gland, MRI is done to investigate further. The doctor will see abnormalities in the hypothalamus or pituitary gland, eg whether there is a tumor.

Treatment Of Diabetes Insipidus

Treatment of diabetes insipidus depends on the type suffered. Treatment is done to reduce the amount of urine produced by the body and control the symptoms that arise.
Treatment of Cranial Diabetes Insipidus

If you produce 3-4 liters of urine in one day (24 hours), this condition is considered a mild cranial diabetes insipidus. This condition does not require special treatment. You can relieve symptoms that appear by increasing your water consumption to avoid dehydration. The doctor will suggest at least 2.5 liters of diet a day.
If the condition you are experiencing is severe enough and caused by the low production of antidiuretic hormone, then consuming plenty of water is not enough to relieve the symptoms that appear. Here are some medications that may be used to overcome the conditions experienced.
  • Desmopressin . It acts like an antidiuretic hormone. This drug will stop the urine production. Desmopressin is an artificial antidiuretic hormone and has a stronger function than the original hormone. This medicine can take the form of nasal sprays or tablets. Possible side effects are headache, abdominal pain, nausea, nosebleeds, or a runny or stuffy nose. To know more about this drug, ask your doctor or pharmacist.
  • Thiazide diuretic. This drug serves to make the urine becomes more concentrated by reducing the water content. Side effects that may occur due to this drug is dizziness when standing, digestive disorders, the skin becomes more sensitive, and for men, experiencing erectile dysfunction.
  • Anti- Drug I Nfl amasi Non -s teroid. If this group of drugs is combined with thiazide diuretics, these drugs can decrease the amount of urine released by the body.

    Treatment of Nephrogenic Diabetes Insipidus

If the condition you are experiencing is caused by medications such as lithium and tetracycline, a hormonal disease specialist will ask you to stop taking them and look for a replacement medicine. If not recommended by a doctor, do not stop taking medications that have been prescribed by a doctor.
If the kidney organ is disturbed and can not respond to the antidiuretic hormone causing diabetes insipidus nefrogenik, then you will be advised to drink lots of water to avoid dehydration. Desmopressin drugs can not cope with this condition.
Reducing salt intake will also help the kidneys in storing water and reducing urine volume. Be sure to consult a doctor before changing your diet. To reduce the amount of urine production from the kidney organ, a combination of thiazide diuretics and non-steroidal anti-inflammatory drugs will be prescribed to severe niprogenic diabetes insipidus.

Complications Of Diabetes Insipidus

If diabetes insipidus is not detected early or not handled properly, this condition can lead to some complications as below.

Electrolyte Imbalance

Electrolytes are minerals such as calcium, sodium, chlorine, potassium, magnesium, and bicarbonate. This mineral content serves to maintain water balance in the body and play a role in cell functions. Symptoms that may occur due to this condition are:
  • Fatigue or run out of energy.
  • Headache.
  • Pain in the muscle.
  • Easy to get angry.
  • Nausea and loss of appetite.
Dehydration is the most common impact when the body can not maintain enough fluid in the body due to diabetes insipidus. Symptoms arising from dehydration include:
  • Dry mouth and lips.
  • Dizziness or headache.
  • Low blood pressure (hypotension).
  • Fever.
  • Confusion and irritability.
  • Rapid heartbeat.
  • Weight loss.
For mild dehydration conditions, can be treated with ORS. As for the severe conditions, you may need to be hospitalized to get fluids through the IV.

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