Mean LOS 63 days Description Medical Endocrine Disorders with CC

The disorder diabetes insipidus (DI) is characterized by excretion of large amounts of dilute urine. DI can be of central (neurogenic) or renal (nephrogenic) origin. In central DI, excess urine is caused by insufficient amounts of antidiuretic hormone (ADH, also known as plasma vaso-pressin). Renal DI occurs when the kidney has a decreased responsiveness to ADH. The overall incidence of DI in the general population is approximtely 3 cases per 100,000 population.

Normally, body water balance is partially regulated by ADH, which is produced in the hypothalamus and is released from the posterior pituitary gland when body fluids become more concentrated than usual (serum osmolality >283 mOsm/L). ADH causes water reabsorption in the distal portions of the nephron of the kidney by increasing the number of pores in the distal tubular system to allow for water reabsorption. ADH deficiency leads to little or no reabsorption; as a consequence, dilute urine formed in more proximal parts of the nephron is excreted essentially unchanged. The loss of solute-free water causes mild dehydration, a rise in plasma osmolality, and the stimulation of thirst.

Complications are most likely in patients with decreased mental alertness because their impairment makes it less likely they will drink in response to their stimulated thirst. The most serious complication of untreated DI is hypovolemia that may lead to hyperosmolarity, loss of consciousness, circulatory collapse, shock, and central nervous system (CNS) damage.

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