【英文PPT精品课件】MEDICAL GRANDROUNDS ON DIABETES INSIPIDUS.pptVIP

Osmolar Clearance vs Free Water Clearance Solute H20 urine Osmolar Clearance (Cosm) = Uosm x V -------------- Posm Uosm = 120 Posm = 326 Vol = 8.8L Cosm = 120 x 8.8 326 Cosm = 3.23L Urine vol =8.8L 3.3L (Osm) 5.5L (H20) Conclusion Polyuria is secondary to water diuresis Polyuria secondary to water diuresis Nephrogenic DI (? hypercalcemia) vs Central DI (? metastasis) Trial of DESMOPRESSIN (0.2mcg 1/2tab BID) Effect on urine volume and osmolality After the trial of Desmopressin Urine Volume 100% 8.8L ? 4.6L Urine Osmolality 100% 120 ? 423 Conclusion : CENTRAL Diabetes Insipidus WITHDRAWAL OF DESMOPRESSIN Urine OSMOLALITY: 423 ? 213 Urine Volume Urine Osmolality Input and Output Monitoring 16th HOSPITAL DAY – Brain MRI Nodules in the pineal region and hypothalamus with thickening of the pituitary stalk. Enhancing nodules in the left parieto occipital area, head of the right caudate nucleus, left basal ganglia, left cerebellar hemisphere. Leptomeningeal thickening and enhancement, left temporal area. Enhancing bone foci in both frontoparietal and left temporal bones. Above findings considered metastases Clinical Outcome Discharged stable on the 24th hospital day POLYURIA AND DIABETES INSIPIDUS POLYURIA Polyuria can be arbitrarily defined as a urine output exceeding 3 L/day in adults and 2 L/m2 in children Causes Primary polydipsia Central Diabetes Insipidus Nephrogenic Diabetes Insipidus Diagnostic Approach to Polyuria Onset of polyuria Family history Plasma Na concentration Na 137 meq/L, due to water overload, is usually indicative of primary polydipsia Na 142 meq/L, due to water loss, points toward DI Water restriction test Plasma ADH measurement Water Restriction Test MEDICAL GRANDROUNDSON DIABETES INSIPIDUS Desiree B. Yano-Simbulan, M.D. Maricel B. Peniero, M.D. November 8, 2007 LEARNING OBJECTIVES To present a case of a 50 year old female with diabetes insipidus To provide an overview in the diagnostic approac