Diagnosis and differential diagnosis of diabetes
Endocrinology / / August 12, 2017
Diagnosis of the disease is based on the characteristic symptoms - increased thirst and release of large amounts of low specific gravity of urine.
To clarify the nature of the pathological process that caused the violation of vasopressin production, all patients should have a thorough neurological, radiological and ophthalmologic examination.
The differential diagnosis is carried out with psychogenic polydipsia, diabetes, kidney disease (chronic renal insufficiency in nephrosclerosis, "nephrogenic diabetes insipidus", renal tubular necrosis, and so on. P.), Violation of renal tubular function in connection with hypercalcemia with hyperparathyroidism or hypokalaemia whenprimary aldosteronism.
for the differential diagnosis of diabetes insipidus and psychogenic polydipsia used to test fluid deprivation.Due to the fact that the deprivation of the fluid of patients with diabetes insipidus can cause severe dehydration phenomenon, the sample must be carried out only in a hospital at the systematic observat
If unable to properly conduct tests with the deprivation of the liquid sample can be carried out with intravenous saline solution.The sample is based on the fact that the increase in osmotic pressure of blood in healthy individuals and patients with neurogenic polydipsia causes irritation osmoreceptors, increasing vasopressin release and decrease in urine output.In patients with diabetes insipidus diuresis not reduced.According to the method of Carter and Robbins test is conducted as follows: in the morning on an empty stomach the patient give a drink of water at the rate of 20 ml per 1 kg of body weight.Half an hour later the patient establish a permanent catheter and measure the amount of urine for every 15 minutes.Once a stable level established diuresis begin drip into a vein of 2.5% saline solution at the rate of 0.2-0.25 ml per 1 kg body weight over 45 minutes while continuing to measure urine output.
and other modifications are suggested to load the sample table salt, including taking samples with sodium chloride inside.
sample with a load of salt is not sufficiently reliable method for the differential diagnosis of diabetes insipidus and nerve polidipeii.Popov observed normal reaction to the introduction of salt in some patients with diabetes insipidus, a Daughaday indicates that some patients nervous polydipsia diuresis may not decrease when administered saline.
sample in which to stimulate production of antidiuretic hormone used nicotine is administered intravenously at a dose of 0.5-1.0 mg of non-smokers and smokers to 3 mg is not safe and is often accompanied by unpleasant side effects - nausea, vomiting, etc.
..additional diagnostic significance can use diuretics, which when administered to patients of psychogenic polydipsia increases diuresis and in patients with diabetes insipidus - decreases.
differential diagnosis of diabetes mellitus and diabetes insipidus is not difficult.The presence of glycosuria and hyperglycemia, high urine specific gravity in patients with diabetes provide sufficient grounds for a proper diagnosis.In rare cases, it is the combination of diabetes mellitus and diabetes insipidus.In such patients, the diagnosis of diabetes insipidus can be established only after the removal using appropriate therapy of hyperglycemia and glycosuria.
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In renal insufficiency, daily diuresis rarely exceeds 4 l, urine specific gravity is fixed around1,009-1,010.The differential diagnosis based on the presence of kidney disease with proteinuria, abnormal urinary sediment, increased residual nitrogen of blood, high blood pressure, fundus changes.If you suspect the presence of renal failure before a thorough investigation of patients should not be carried out tests with a load of table salt, nicotine, contraindicated in patients with renal disease.
Test with fluid deprivation and administration of drugs for diagnostic purposes vasopressin when you suspect the presence of renal failure and require great care, monitoring of residual blood nitrogen.
rare diseases, requiring differential diagnosis with diabetes insipidus, is "nephrogenic diabetes insipidus."The disease is caused by genetically happens almost exclusively in males but is transmitted through women.When nephrogenic diabetes insipidus is no renal response to vasopressin.Symptoms of kidney disease do not have this disease.Differential diagnostic value has no decrease in urine output after the administration of vasopressin preparations.
differential diagnosis of diabetes insipidus and hyperparathyroidism is based on availability at the last hypercalcemia, hypophosphatemia, typical skeletal changes, nephrolithiasis or nephrocalcinosis.When hyperparathyroidism diuresis usually does not happen so much, and urine specific gravity - so low, as in diabetes insipidus.
polyuria with primary aldosteronism and usually no less significant, as in diabetes insipidus, and urine specific gravity is not reduced to a level characteristic of the latter disease.Differential diagnosis is also based on the presence of characteristic symptoms of primary aldosteronism - hypokalemia, hypertension, etc.
12 Aug, 2017
12 Aug, 2017