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Diabetes Insipidus, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Disorder in which large volumes of dilute urine are excreted (polyuria) as an inappropriate response to argininevasopressin (AVP)

  • Polyuria defined as >3 L in 24 hr

  • Often characteriz...

Diagnosis

Signs and Symptoms

History

  • Polyuria (up to 16–24 L/d of urine):

    • Note the voiding frequency.

  • Polydipsia (often craves cold fluids):

    • Note the amount of PO fluid intake per day.

  • Drug ingestion

  • Signs a...

Treatment

Pre-Hospital

  • ABCs

  • Immobilize if trauma is suspected.

  • Serum blood glucose

  • IV access and fluids if signs of dehydration exist

  • Control seizures according to medical direction guidelines.

Initial Stabilization/Therapy

Follow-Up

Disposition

Admission Criteria

  • AMS

  • Seizure

  • Severe dehydration

  • Electrolyte abnormalities

  • Associated trauma

  • Patients requiring DDAVP testing or a trial of water restriction

Discharge Criteria

  • Known dia...

Pearls and Pitfalls

  • Check urine osmolality and consider DI in polyuria.

  • Central DI will typically respond to desmopressin.

  • Nephrogenic DI will not respond to ADH:

    • Treat the underlying electrolyte abnorma...

Additional Reading

  • Di lorgi  N, Napoli  F, Allegri  AE, et al. Diabetes insipidus – diagnosis and management. Horm Res Paediatr.  2012;77:69–84.

  • Fenske  W, Allolio  B. Current state and future per...

Codes

ICD9

  • 253.5 Diabetes insipidus

  • 588.1 Nephrogenic diabetes insipidus

ICD10

  • E23.2 Diabetes insipidus

  • N25.1 Nephrogenic diabetes insipidus

SNOMED

  • 15771004 Diabetes insipidus (disorder)

  • 111395007 Nephrogenic...

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