The Diabetes insipidus
The

Diabetes insipidus

Diabetes is non-sugar (a synonym for diabetes insipidus) - a disease accompanied by the release of a large amount of urine - polyuria (see) and thirst - polydipsia (see). Non-diabetes is more common in young men. At the heart of the disease is a decrease in the content of vasopressin - antidiuretic hormone in the blood, which leads to a disruption of water reabsorption in the distal part of the convoluted tubules of the kidney . The consequence is polyuria and compensatory polydipsia . Vasopressin is produced in the nuclei of the hypothalamus (see), then enters the posterior lobe of the pituitary (see), and from there it is released into the blood. The causes of these injuries are various: injuries with a fracture of the skull bones, subarachnoid hemorrhages, acute (measles, diphtheria, chickenpox, etc.) and chronic infections ( syphilis , tuberculosis ), tumors of the central nervous system. During the day, 3-40 liters of light urine with a low specific gravity (1001 - 1005), without sugar are excreted. Usually dry skin and mucous membranes are expressed. Internal organs without much change. The prognosis depends on the underlying disease; complete recovery usually occurs if insipid diabetes develops on the basis of acute or chronic infection.

The

Treatment . Apply the etiological treatment if the cause is established (for example, in central nervous system tumors - X-ray therapy or surgery), and pathogenetic - intranasal administration of adiurecrin to 0.05 g 3 times daily or injection of pituitrin under the skin or intramuscularly 1 ml 3-4 times a day. Diet with restriction of salt and meat. To combat thirst - lemons, apple compote, apple puree in a cold form.

Diabetes is insipid (a synonym for diabetes insipidus) - a neurohypophysis syndrome characterized by polydipsia and polyuria with urine release with a reduced specific gravity in the absence of glycosuria and kidney damage.

Etiology: infections, tumors and traumas of the brain and pituitary gland, hypophysectomy. In some cases, the disease is hereditary predisposition.

Pathological anatomy. When the disease affects the supraoptic nucleus, the posterior lobe of the pituitary gland or the path connecting these formations.

Pathogenesis. In diabetes insipidus, the production of the antidiuretic hormone by neurosecretory cells of supraoptic and paraventricular nuclei of the hypothalamus decreases. The lack of an antidiuretic hormone causes a disruption of the reabsorption of water in the distal sections of the convoluted tubules of the kidneys, polyuria and polydipsia.

Clinical picture (symptoms and signs). The main clinical signs are thirst and profuse urination. A patient can drink more than 12 liters of liquid a day. Urine is light, specific weight drops to 1001-1005. Isolation of salts is normal, but their concentration is very low.

Decompensated polyuria leads to dehydration of the body followed by mucosal dehydration, headaches, fever, nausea, swallowing, vomiting, stopping sweating, and psychomotor anxiety, which is accompanied in some cases by delirium.

Polyuria and polydipsia often lead to the development of insomnia. There may be visual impairment, tachycardia and vasomotor disorders. Violated the higher nervous activity . The main exchange remains normal. Carbohydrate metabolism is rarely disturbed, only in the case of a combination of diabetes insipidus and diabetes.

The

Diagnosis of diabetes insipidus is based on the presence of polyuria, polydipsia, low specific gravity of urine.

It is necessary to distinguish diabetes insipidus from sugar, psychogenic polydipsia, chronic diffuse glomerulonephritis, hyperparathyroidism.

In diabetes, usually the specific gravity of urine is increased, there is a glycosuria; Hyperglycemia, polydipsia and polyuria are less developed.

With psychogenic polydipsia, patients drink plenty of water and emit a lot of urine on the basis of mental disorders. These patients (in contrast to patients with diabetes insipidus) tolerate thirst well, they have a dry weight increase in the specific gravity of urine, treatment of such patients with drugs of the posterior lobe of the pituitary gland is ineffective. If you can not try dry eating, you can enter into the vein a hypertonic solution of sodium chloride, which, in case of psychogenic polydipsia, in contrast to diabetes insipidus, reduces the amount of urine that is separated.

In the stage of compensatory polyuria in chronic diffuse glomerulonephritis, in contrast to diabetes insipidus, 3-4 liters of urine are isolated per day, its specific gravity is 1.010; an increase in the level of residual nitrogen in the blood, the presence of protein in the urine and granular cylinders also speaks against diabetes insipidus.

In hyperparathyroidism, not only polyuria, but also hypercalcaemia and hypercalciuria not characteristic of diabetes insipidus are noted.

The prognosis depends on the nature of the underlying disease that caused the development of diabetes insipidus. If this disease does not progress, then the prediction is good for life, but with respect to recovery is unfavorable.

Treatment . In all cases it is necessary to treat the underlying disease. Inflammatory forms of the syndrome of diabetes insipidus of syphilitic, tubercular, viral origin are subject to specific treatment (antibiotics, antibacterial drugs, antileuutics).

Hormone therapy with adiurecrin or pituitrin is an effective substitute. The antidiuretic effect lasts 3-5 hours after intranasal administration of 0.05 g of adiurecrin and 6-8 hours after the administration of pituitrin under the skin. The action of the hormone is prolonged to 2-5 days with the use of injections of pittresin-tannata or antidiuretic hormone in the form of fatty suspension.

Intranasal administration of adiurecrin is noticeably inferior to other methods of its administration (in gelatin capsules, in the form of chewing gum, slightly soluble sweets, suppositories).

In case of an overdose of the drugs in the posterior lobe of the pituitary gland, edema of the brain tissue may occur, in which vomiting, headaches, convulsions are observed. In such cases, hormonal drugs are canceled and diuretics are prescribed.

For tumors that caused the development of diabetes insipidus, X-ray therapy or surgery is performed.

Recently, substances that block the release of water - glyceric acid, chlorothiazide, etc., have been recommended. Pyramidone and barbiturates are also used to reduce headaches and calm the nervous system.

Prevention of the disease consists in preventing infectious diseases that can cause it.

Employment and work capacity of patients. Patients can perform work that is not associated with constant monitoring of a certain technological process. In case of tumor processes, patients need rest, with meningoencephalitis the loss of ability to work is temporary.