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polyuria
Loosely defined as a 24 hour urinary output of > 3 liters.
Etiology:
1) diabetes insipidus
a) central (vasopressin-responsive)
b) nephrogenic
- acquired renal tubulointerstitial disease
- drugs or toxins
- congenital syndromes
2) solute diuresis
a) glucosuria
b) high-protein tube feedings
c) urea or mannitol infusion
d) radiographic contrast media
e) chronic renal failure
3) natriuretic syndromes
a) salt-losing nephritis
b) diuretic phase of acute tubular necrosis (ATN)
c) diuretics
4) primary polydipsia
a) psychogenic
b) hypothalamic disease
c) pharmaceutical agents
- thioridazine
- chlorpromazine
- anticholinergic agents
Laboratory:
- plasma copeptin* distinguishes diabetes insipidus from primary polydipsia [4]
* fragment of the arginine vasopressin prohormone
Related
nocturia
polydipsia
General
sign/symptom
References
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook, Isselbacher et al (eds), McGraw-Hill
Inc. NY, 1995, pg 829-39
- Guide to Physical Examination & History Taking, 4th edition,
Bates B, JB Lippincott, Philadelphia, 1987
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY,
1994, pg 239
- Fenske W, Refardt J, Chifu I et al.
A copeptin-based approach in the diagnosis of diabetes insipidus.
N Engl J Med 2018 Aug 2; 379:428.
PMID: 30067922
https://www.nejm.org/doi/10.1056/NEJMoa1803760
- Rosen CJ, Ingelfinger JR.
A reliable diagnostic test for hypotonic polyuria.
N Engl J Med 2018 Aug 2; 379:483.
PMID: 30067935
https://www.nejm.org/doi/10.1056/NEJMe1808195