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COULD I / MY CHILD HAVE DI
Question # 0005 FAQ Keywords: diagnosis, diagnostic tests, 24-hour urine
volume
I am currently working with a doctor to see if I have DI. I drink up to 96
oz. of fluid per day. I urinate up to 22 times per day. This includes up to
three times in the night. My urine is sometimes yellow colored, but often very
pale and diluted looking. We have ruled out kidney stones, urinary tract
infection, bladder infection, bladder urge increase, and sugar diabetes. She is
running tests for sodium level, potassium, and a 24-hour urine collection. My
urine volume for 24 hours was approximately 2650 ml.
* Are there other tests that should be done?
* What would be a “normal” 24-hour urine volume?
* Is that volume level consistent with DI?
A 24-hour urine collection for measurement of total volume,
osmolality, and
creatinine is sufficient to determine if you have DI. After that, additional
tests are required to determine the type of DI. If the 24-hour urine volume you
report is complete and accurate, it is very unlikely that you have DI of any
type (unless you are very small i.e., weight less than 100 pounds). The upper
limit of normal for a 24-hour urine volume for an adult is 50 ml. per kg. of
body weight.
Question # 0625 EWv6n2 Keywords: diagnosis, diagnostic tests, frequent
urination
Is there a form of DI that is mild enough to cause frequent urination with no
accompanying increase in thirst during these episodes, but with increased (not
excessive) thirstiness in between the episodes? During the episodes of frequent
urination, which can last for a few hours up to a few days, my urine is often
colorless. I have been tested for glucose in the urine, but the results are
always negative.
* Should I be tested for DI?
Thirst and urination do not necessarily occur at the same time in DI. If you
think that both may be increased, you should be tested for DI. The best way is
simply to collect a 24-hour urine and measure the volume, osmolality, and
creatinine content. If the latter is normal, the volume is high, and the
osmolality is low, you have DI and should be evaluated further to determine the
type.
Question # 0626 EWv6n2 Keywords: septo optic displasia, SOD, diagnosis,
diagnostic tests
Someone I know is exhibiting many symptoms of DI (attempting to drink
excessive amounts of fluid, excessive urination, behavioral outbursts, etc.).
She has been diagnosed with septo optic displasia (SOD). She has started to go
to extremes to get fluids, such as drinking out of the toilet.
What testing would be helpful to rule out DI? Who does this type of testing?
Collect a 24-hour urine and have it measured for total volume,
creatinine,
and osmolality. That plus the patient’s weight would give an indication of
whether the child has DI. The tests can be ordered and performed by any local
doctor and laboratory. If the results indicate DI, the next step is to determine
the type. However, CDI is often associated with SOD. There is another test that
can diagnose DI and determine which form, called the water deprivation test. The
guidelines for this test are available on DiF’s web site at
www.diabetesinsipidus.org/water_deprivation_protocol.htm. This diagnostic test
should only be performed under the close supervision of a physician experienced
in performing this test and in a hospital setting.
Question # 0627 EWv6n2 Keywords: polydipsia, white matter disorder
I have a 6-year-old son with an undiagnosed white matter brain disorder. He
is profoundly deaf and mentally retarded. He also has an unknown pigment in his
urine which tests positive for hemoglobin, and he has myoclonic seizures,
chewing difficulties, autistic traits, attention-deficit/hyperactivity disorder,
and ataxia. When be was younger, he was hospitalized for dehydration due to him
refusing to drink for one month. Now be drinks continuously and therefore wets
continuously. He is still in diapers and this becomes a problem in keeping him
dry, especially when we are in public. I mentioned this at his last neurology
appointment and the resident said he felt like it could be DI due to his brain
not being formed right. His neurologist came behind the resident and said “no”
that they were just going to call it idiopathic polydipsia and he has ordered a
repeat EEG. Is excessive drinking a common problem you see with white matter
disorders, and could this be DI as the resident suggested?
The symptoms you describe could be due to CDI or to a primary abnormality in
his thirst mechanism. He should be evaluated for these possibilities; if he has
CDI, it can be controlled easily and effectively with dDAVP or other
antidiuretic medications. I do not know if the disease of his white matter is
responsible for his drinking excessively, but it certainly could be. Since he
has probably had an MRI, you should ask the neuroradiologist to review it to see
if his posterior pituitary bright spot is absent. If it is, the likelihood is
that he has CDI.
Question # 0451 EWv4n3 Keywords: diabetes mellitus, sugar diabetes
I have recently been diagnosed with DI and diabetes mellitus (sugar diabetes)
by my endocrinologist and have been prescribed with dDAVP to control the former.
My wife has been bugging me to contend my doctor on her diagnosis of diabetes
mellitus because when I took my glucose tolerance test, I was dehydrated (it
seems that the liver produces a lot of glucose when the body is dehydrated).
When I asked my doctor about it, she gave it no second thought and merely said
“you have diabetes mellitus and DI.” Could she be wrong?
Dehydration is rarely a side effect of DI if fluid intake is maintained.
Also, it is not likely to cause or be confused with diabetes mellitus. The
diagnosis of DI in the presence of diabetes mellitus would be very difficult
unless or until the hyperglycemia and glucosuria is corrected.
CAN I DIE FROM DI
Question # 0008 FAQ , 0282 EWv2n4
Keywords: prognosis, mortality, medical alert card, medical alert bracelet,
traveling, life expectancy
* What is the mortality rate of diabetes insipidus?
Even if untreated, DI does not cause death or reduce life expectancy unless
the patient gets into a situation in which he or she cannot get an adequate
supply of drinkable water. This can happen, for example, if the patient loses
consciousness, is unable to talk or move about, or is stranded in the desert or
ocean (sea water is undrinkable). Therefore, it is a good idea always to carry a
medical alert bracelet or card and to take extra precautions to carry extra
water as well as medication when traveling in areas in which either may be
difficult to obtain.
Question # 0676 EWv6n2 Keywords: prognosis, mortality, life expectancy
* Does CDI cause any problems other than increased urination, thirst, and
drinking?
* Does CDI shorten one’s life span?
As far as we know, CDI does not cause any other disabilities or health risks,
provided there is no interference with the ability to replace the lost fluid. If
water intake is impaired (for example, by loss of consciousness or by separation
from an abundant supply of drinkable water) there is a very grave risk of severe
dehydration that could lead to serious brain damage or even death. Treatment
reduces the risk because it reduces the rate of water loss and thereby lengthens
the time one can go without drinking. However, it does not eliminate the risk
altogether because there is always the possibility that medication will be lost
or run out. For this reason, it is important to always carry an adequate supply
of medication and be careful about getting in a situation where a good supply of
water is not available (for example ocean sailing or hiking in the mountains or
desert.) Dipsogenic DI or pyschogenic polydipsia does not carry the risk of
dehydration but may result in serious over-hydration (water intoxication) if
dDAVP or other drugs such as thiazide diuretics are taken or if certain acute
diseases such as influenza develop. Therefore, it is important to know if these
disorders are present so that the offending drugs can be avoided or the
appropriate tests and countermeasures can be applied as soon as a disease or
ailment like influenza develops.
Did you see a typo, misspelling, or other error in this FAQ
page? We want to know. Please email
us the error specifics and the page where you found the error.
The questions in this FAQ have been published in Endless
Water, the newsletter of the Diabetes Insipidus Foundation. If you are not
currently a member of the Diabetes Insipidus Foundation, you can receive a free
sample issue of Endless Water. Endless Water has articles on DI
and answers to questions that other people have submitted to the DiF. For a free
issue, please contact the editor. The free issues are normally sent as an Adobe Acrobat (PDF) file
by e-mail. You can also ask for a paper copy if you prefer.
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Last Updated January 2007
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