The amount of urine excreted from the body is determined by the state of water and electrolytes in the body. In a normal case, vasopressin is produced by the hypothalamus in the brain and stored and secreted by the posterior pituitary gland. Adults usually urinate 6-7 times a day, a total of 1-2L. Vasopressin is an antidiuretic hormone that regulates the state of water in our body. Diabetes insipidus refers to a disease in which the pituitary gland does not store and secrete vasopressin properly, or the secreted vasopressin does not work properly in the kidneys, resulting in an abnormally large amount of urine and severe thirst. Diabetes insipidus is largely divided into central diabetes insipidus, in which vasopressin is insufficiently secreted by the brain, nephrogenic diabetes insipidus, which causes abnormalities in the kidneys where vasopressin works, and primary polydipsia due to excessive water intake. In the case of central diabetes insipidus, nerve cells in the hypothalamus that produce vasopressin do not occur due to congenital reasons, or it can be caused by various factors such as head injury, tumor, infection, surgery, and vascular disease. In addition, it is known that nephrogenic diabetes insipidus, which is caused by the failure of kidney cells to respond normally to vasopressin, can be caused by several factors such as long-term kidney disease, hypokalemia, and drugs that cause kidney problems. In addition, primary polyposis is said to be caused by the inhibition of vasopressin by excessive water intake. Now, let’s learn about the various symptoms, treatment, and management of diabetes insipidus, one by one.
Main symptoms of diabetes insipidus
The main symptom of diabetes insipidus is polyuria, which results in excessive urination. Since you usually urinate more than 5L per day, you will urinate a lot at once every 1 to 2 hours, and at the same time, the following symptoms will appear as you consume a large amount of water to replenish the lost fluid. In addition, excessive thirst is continuously felt, and a large amount of water is consumed, which may cause decreased appetite, dryness of the oral mucosa and skin due to burning, and weakness. Additionally, you may develop nocturia, which increases the number of times you urinate at night.
If the symptoms of diabetes insipidus become more severe, fainting or fever may occur, and frequent urination at night may accompany sleep disturbance symptoms. In addition, children, the elderly, and those with certain diseases, who have difficulty in supplying sufficient water, not only cause more severe dehydration, but are also at risk of complications related to hypernatremia, hypertension, and cardiovascular disorders. In particular, in the case of infants and children, if dehydration is not performed, fever and vomiting may occur, and in severe cases, brain damage may occur. Therefore, if several related symptoms appear, it is recommended to proceed with an appropriate diagnosis and examination process through a visit.
Diagnosis and treatment of diabetes insipidus
1. Accurate diagnosis through multiple tests
Diabetes insipidus is diagnosed with a physical examination, blood test, urine test, and MRI, as well as a questionnaire based on the amount of water you drink per day, the number and amount of urination, and past medical history. In order to confirm the occurrence of diabetes insipidus in more detail, a water restriction test is performed to observe whether urine is not concentrated well in the state of not drinking water, and the osmotic pressure of urine and blood is measured to determine the change pattern.
2. Appropriate treatment according to the diagnosis result
Through this diagnostic process, if primary polydipsia due to excessive water intake is confirmed, there is no abnormality in the secretion of hormones and the kidneys. However, in case of central diabetes insipidus caused by insufficient production of antidiuretic hormone in the posterior pituitary, antidiuretic hormone or an antidiuretic hormone inducer is administered through nasal sprays or injections. In the case of nephrogenic diabetes insipidus, which secretes enough antidiuretic hormone but does not function well to reabsorb water by the kidneys, a low-sodium diet is implemented and treatment using drugs such as Tiwazide is carried out at the same time.
3. Control water retention
In the case of diabetes insipidus, drinking less water on your own to control the amount of fluid excreted can not only lead to severe dehydration, but also can lead to hypernatremia due to the accumulation of sodium in the fluid excreted. Therefore, it is important to drink plenty of water to avoid dehydration, and to adjust the concentration of the treatment drug and water intake according to the doctor’s instructions.
And in the case of nephrogenic diabetes insipidus, it is important to refrain from consuming foods high in salt in the diet to prevent hypernatremia. In addition, beverages such as coffee, green tea, and black tea are foods that have diuretic effects that promote the excretion of water from the body and can cause worsening of symptoms such as diabetes insipidus and nocturia.