DIABETES INSIPIDUS课件.ppt

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 approach to polyuria and diabetes insipidus To discuss nephrogenic versus central diabetes insipidus: etiology, clinical manifestation, work up and management IDENTIFYING DATA A.G. 50y/o female Filipino cc: epigastric pain HISTORY OF PRESENT ILLNESS 2 weeks PTA (+)epigastric pain (+)bloatedness (+)loss of appetite (-) nausea, vomiting (-)changes in bowel habit EGD: Gastritis Gastric polyp Few days PTA (+)persistence of symptoms A REVIEW OF SYSTEMS No fever No blurring of vision, no visual loss No throat pain, tinnitus, no hearing loss No dyspnea, no cough, no hemoptysis No chest pain, no palpitation, no orthopnea (+) polydipsia (+) polyphagia (+) nocturia (+) right hip pain (+) low back pain No skin rash or skin changes PAST MEDICAL HISTORY Invasive Ductal Carcinoma, Left Breast s/p Modified Radical Mastectomy,left breast 2003 s/p Chemotherapy 2003, 2004 s/p Radiotherapy, 2006 Hypertension, 2004 Atenolol (Therabloc) 50mg 1/2tab OD Imidapril (Vascor) 5mg OD Diabetes Mellitus, 2000 Acarbose (Glucobay) 50mg OD Repaglinide (Novonorm) 0.5mg OD s/p laparoscopic cholecystectomy, 2004 FAMILY HISTORY (+) Breast cancer – 2 cousins (+) Diabetes Mellitus – mother, brother PERSONAL/SOCIAL HISTORY non smoker non alcoholic beverage drinker no history of substance abuse worked as a general accountant PHYSICAL EXAMINATION Gen. Survey: Awake, alert not in cardiorespiratory distress Vital Statistics: Ht:157cm Wt:58kgs BMI: 23 Vital Signs: BP:110/70 CR:95 RR:20 To:36.6 Skin: warm, moist, no rash HEENT: pink palpebral conjunctivae, anicteric sclerae, supple neck, no tonsillopharyngeal congestion, no neck vein distention, JVP = 10cm PHYSICAL EX