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Physiology

Endocrine

Question 71 of 180

Which of the following is NOT a typical clinical feature in diabetes insipidus:

Answer:

The biochemical hallmarks of DI are:
  • High plasma osmolality (> 295 mOsm/kg)
  • Low urine osmolality (< 300 mOsm/kg)
  • Hypernatraemia (> 145 mmol/L)
  • High urine volume

Diabetes Insipidus

Diabetes insipidus (DI) may result from a deficiency of ADH secretion (cranial DI) or from an inappropriate renal response to ADH (nephrogenic DI).

As a result, fluid reabsorption at the kidneys is impaired, resulting in large amounts of hypotonic, dilute urine being passed with a profound unquenchable polydipsia.

Biochemical Features

The biochemical hallmarks of DI are:

  • High plasma osmolality (> 295 mOsm/kg)
  • Low urine osmolality (< 300 mOsm/kg)
  • Hypernatraemia (> 145 mmol/L)
  • High urine volume (> 3L/24h)

Causes

  • Cranial (ADH deficiency)
    • Inflammatory hypophysitis
    • Histiocytosis X
    • Post-pituitary surgery
  • Nephrogenic (ADH resistance)
    • Metabolic or electrolyte disturbance
    • Renal disease
    • Drugs e.g. lithium

An ADH stimulation test can distinguish between cranial and nephrogenic DI, as nephrogenic DI shows an inability to concentrate urine even after administration of synthetic ADH.

Management

Patients with confirmed cranial DI should be investigated for pituitary disease, and managed as appropriate. Cranial DI typically responds well to synthetic ADH administration and results in good clinical improvement.

In nephrogenic DI, the underlying cause should be considered and reversed where possible. If symptoms persist, patients should drink according to thirst and keep up with water loss. Specific measures to treat nephrogenic DI include the use of low salt, low protein diet, diuretics and NSAIDs.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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