Diabetes insipidus natural history, complications and prognosis

Jump to navigation Jump to search

Diabetes insipidus Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Diabetes insipidus from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-Ray

CT scan

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Diabetes insipidus natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Diabetes insipidus natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Diabetes insipidus natural history, complications and prognosis

CDC on Diabetes insipidus natural history, complications and prognosis

Diabetes insipidus natural history, complications and prognosis in the news

Blogs on Diabetes insipidus natural history, complications and prognosis

Directions to Hospitals Treating Diabetes insipidus

Risk calculators and risk factors for Diabetes insipidus natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

If left untreated, diabetes insipidus results in an elevation in serum sodium and osmolality. The hyperosmolarity seen in this patients may also present with neurologic symptoms such as confusion, altered mental status, seizures, coma and death. The two major complications of diabetes insipidus are dehydration and electrolyte imbalance . Some research also demonstrates that there is decrease in bone mineral density seen in patients with diabetes insipidus. However the mechanism of development is not clearly understood neither is the treatment clearly accounted for because treatment of diabetes insipidus does not reverse the disorder.

Natural History

Diabetes insipidus if left untreated results in an elevation in serum sodium and osmolality. The hyperosmolarity seen in this patients may also present with neurologic symptoms such as confusion, altered mental status, seizures, coma and death.

The serum sodium concentration in untreated central diabetes insipidus is often in the high to normal range. This is required in order to provide the sensation of thirst in a patient and stimulate drinking in order to replace the water lost in the urine. However in patients that have some form of central nervous disorders, moderate to severe hypernatremia can develop as thirst is impaired or cannot be expressed. This can also occur in infants and young children who cannot independently access free water, and in the postoperative period in patients with unrecognized diabetes insipidus (DI).

Patients with CDI may develop decreased bone mineral density at the lumbar spine and femoral neck, even in those treated with desmopressin (dDAVP).[1] It is unclear how the deficiency of ADH results in bone loss, particularly since treatment fails to prevent bone disease. However, since ADH acts upon both V1 and V2 receptors and desmopressin principally upon V2 receptors, one possible mechanism is that activation of V1 receptors stimulates bone formation.

Complications

There are two major complications of untreated diabetes insipidus. They are:

Dehydration: Due to the inability of the body to retain water, patients with diabetes insipidus are prone to dehydration if the water lost is not appropriately restored by giving IV fluids in the hospital as oral drinking of water may not be sufficient to restore lost water at the same rate especially in infants and the elderly. It is important to watch out for signs and symptoms of dehydration which include:

Electrolyte imbalance: Diabetes insipidus can also cause an electrolyte imbalance. Some of the electrolyte imbalances include hypernatremia from polyuria (seen in both central and nephrogenic DI), hyponatremia from polydipsia (seen in psychogenic DI), hypokalemia and hypercalcemia. Polydipsia can cause an increase in the concentration of these electrolytes simply because of decrease in the plasma concentration of the blood. Dehydration disrupts other functions of the body, such as the way muscles work. It is important to watch out for features such as;

Prognosis

The prognosis of diabetes insipidus is good as long as the underlying cause is identified early before the onset of complications and treated early.

References

  1. Pivonello R, Colao A, Di Somma C, Facciolli G, Klain M, Faggiano A, Salvatore M, Lombardi G (1998). "Impairment of bone status in patients with central diabetes insipidus". J. Clin. Endocrinol. Metab. 83 (7): 2275–80. doi:10.1210/jcem.83.7.4987. PMID 9661594.


Template:WikiDoc Sources