DIABETES INSIPIDUS

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DIABETES INSIPIDUS

• BY BARBARA GLAZE and
• DANA WILLOUGHBY

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What Is Diabetes Insipidus (DI)?

• Unlike Diabetes Mellitus, Diabetes Insipidus is
  characterized by large amounts of dilute urine
  that disrupts the bodys water regulation. DI IS
  NOT A RESULT OF INSULIN DEFICIENCY OR RESISTANCE,
  WHICH CAUSES HIGH BLOOD GLUCOSE. Diabetes
  Insipidus and Diabetes Mellitus are unrelated.

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NORMAL FLUID REGULATION IN THE BODY

• In normal fluid regulation within your body, the
  kidneys remove the extra fluids from your
  bloodstream. If your systems is working
  properly, your kidneys make less urine to
  conserve fluid when the body is losing water, and
  when the bodys metabolic processes are slower.

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NORMAL FLUID REGULATION IN THE BODY (CONT.)

• The rate of fluid intake is governed by thirst,
  and the rate of excretion is governed by the
  production of ADH (antidiuretic hormone) aka
  vasopressin. When ADH reaches the kidneys, it
  directs the kidneys to concentrate the urine by
  returning excess water to the bloodstream,
  therefore making less urine.

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Normal Fluid Regulation in the Body (Cont.)

• Diabetes Insipidus occurs when the system for
  regulating the kidneys handling of fluids is
  disrupted.

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TYPES OF DIABETES INSIPIDUS

• There are four (4) types of Diabetes Insipidus
• 1) Cental Diabetes Insipidus.
• 2) Nephrogenic Diabetes Insipidus.
• 3) Dispogenic Diabetes Insipidus.
• 4) Gestational Diabetes Insipidus.

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CENTRAL DIABETES INSIPIDUS AKA NEUROGENIC DI

• RESULTS FROM DAMAGE TO THE PITUITARY GLAND BY
  HEAD INJURY, NEUROSURGERY OR GENETIC DISORDER.
  This results in a deficiency of antidiuretic
  hormone (ADH).

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NEPHROGENIC DIABETES INSIPIDUS

• AKA VASOPRESSIN-RESISTANT. IS CAUSED BY THE
  INSENSITIVITY OR INABILITY, OF THE KIDNEYS TO THE
  EFFECTS OF ADH.
• THE KIDNEYS ABILITY TO RESPOND TO ADH CAN BE
  IMPAIRED BY CERTAIN DRUGS LIKE LITHIUM BY
  PARTIAL BLOCKAGE OF THE URETERS AND GENETIC
  DISORDERS.

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DISPOGENIC DI

• IS CAUSED BY A DEFECT OR DAMAGE TO THE THIRST
  MECHANISM, LOCATED IN THE HYPOTHALMUS, RESULTING
  IN AN ABNORMAL INCREASE IN THIRST AND FLUID
  INTAKE THAT SUPPRESSESS ADH SECRETIONS AND
  INCREASE URINE OUTPUT.

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GESTATIONAL DI

• THIS TYPE OCCURS DURING PREGNANCY, WHEN AN ENZYME
  MADE BY THE PLACENTA DESTROYS ADH IN THE MOTHER.

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• CAUSES OF DIABETES INSIPIDUS

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Neurogenic DI

• ACQUIRED brain tumors head trauma
  granulomatous diseases autoimmunity idiopathic
  inherited autosomal dominant or recessive
  mutation in the vasopressin gene X-linked
  recessive mutation in an unknown gene.

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Nephrogenic DI

• ACQUIRED Hypokalemia, hypercalcemia, lithium
  inherited X-linked recessive mutation in
  vasopressin receptor autosomal recessive or
  dominant mutation in water channel.

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Polydipsic DI

• ACQUIRED Idiopathic (most) chronic meningitis
  granulomatous diseases multiple sclerosis or
  other diffuse pathology of the brain psychiatric
  illness.

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Gentagenic DI

• ACQUIRED Pregnancy.

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Prevention

• Extremely hard to prevent.
• Reducing the risk of head injuries.
• Early detection and treatment of infections may
  reduce the risk.

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Diagnosis

• The common forms used for diagnosing Diabetes
  Insipidus are mainly urinalysis and a fluid
  deprivation test.
• At this time, there is no current cure for the
  disease.

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GUIDELINES FOR DIAGNOSIS

• YOU SHOULD BEGIN TO SUSPECT DI IF ANY OF THE
  FOLLOWING SYMPTOMS OCCUR
• URINARY FREQUENCY
• NOCTURIA
• ENURESIS
• FREQUENT OR CONSTANT THIRST

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DIABETES INSIPIDUS IN NEWBORNS

• Nephrogenic DI commonly occurs at birth. A WORD
  OF CAUTION In newborn babies, the constant
  thirst and polyuria can easily be mistaken for
  unexplained fussiness. LOOK FOR SIGNS SUCH AS
• UNUSUALLY WET DIAPERS
• FREQUENT NURSING ACCOMPANIED WITH FEVER, AND DRY
  SKIN WITH COOL EXTREMITIES, AND
• INCONSOLABLE CRYING

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Prognosis Life Expectancy

• It is a scientific fact that persons with this
  disease have an excellent outlook on life if they
  take care of themselves and their condition.
• Diabetes Insipidus does not cause death or reduce
  life expectancy unless the person suffering from
  it goes untreated.

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Phenotypes

• This phenotype has not been recorded in human
  families before and has been termed
  Polymorphic.
• Caused by a different mutation within the MIP
  gene.

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Conclusion

• Diabetes insipidus can be very well-managed and
  people can expect to live full and productive
  lives.
• Treatments are great but much depends on
  self-care practices.

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SCENARIO Your client (or parents) have just
been told that their loved one has Diabetes
Insipidus Central DI. They are riddled with
guilt, and wonder what, if anything they could
have done to prevent this illness.I would tell
the parents or the client that this disesase is
one that is hard to prevent. There is very
little they could have done to change what has
happened.Treatment for this particular type of
DI is treating the ADH deficiency with a
synthetic hormone called desmopressin.
Desmopressin is available as an injection, a pill
or a nasal spray.
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Continued

• The parents or client should also be cautioned
  about desmopressin and water intake. While
  treating with this medication, you should only
  drink fluids or water ONLY when thirsty, not at
  other times while just being socialable.
  Desmopressing prevents water excretion and water
  can build up, now that your kidneys are making
  less urine, and are less responsive to changes in
  body fluids.