Polydipsia medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Medical Therapy

Most patients with diabetes insipidus (DI) can drink enough fluid to replace their urine losses. Losses can also be replaced with dextrose and water or IV fluid hyposmolar to the patient's serum. During replacement, avoid volume overload and a correction of hypernatremia that is too rapid. A good rule of thumb is to reduce serum sodium by 0.5 mmol/L/h. Water deficit may be calculated based on the assumption that body water is approximately 60% of body weight in kilograms. In case of inadequate thirst, desmopressin is the drug of choice. Generally, it can be administered 2-3 times per day. Patients may require hospitalization to establish fluid needs. Frequent electrolyte monitoring is recommended. Vasopressin or desmopressin acetate, modified synthetic forms of antidiuretic hormone, may be taken as a nasal spray several times a day, to maintain a normal urine output. However, taking too much of this medication can cause fluid retention and swelling and other problems. Sometimes diabetes insipidus can be controlled with drugs that stimulate production of antidiuretic hormone such as chlorpropamide, carbamazepine, clofibrate. If nephrogenic DI is caused by medication (for example, lithium), stopping the medication may help restore normal kidney function. However, after many years of lithium use, the nephrogenic DI may be permanent. Hereditary nephrogenic DI and lithium-induced nephrogenic DI are treated by drinking enough fluids to match urine output and with drugs that lower urine output. Drugs used to treat nephrogenic DI include: Anti-inflammatory medication (indomethacin)and Diuretics (hydrochlorothiazide (HCTZ) and amiloride).


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