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Chatchai Kreepala,MD
1 step
Differentiated
nocturia
Confirm urine output > 3 L/day or 2
mL/min
Note :normal urine vol 1.6 L
:normal urine soulte 600-900
mosm/day
2 step
approach to polyuria
Polyuria
Urine sp.gr <1.005 or
Urine sp.gr > 1.015 or
Usom <150 or
Usom >250 or
Uosm/Posm <0.9 or
Uosm/Posm >0.9 or
total urine solute < 600 mosm/day or
mosm/day
Urine Osmolar clearance <3 ml/min
ml/min
or
Urine Osmolar clearance <3
FE osm <3%
Water diuresis
Mixed water-solute
(Uosm 150-250 or
FE osm> 3% or
criteria )
Solute diuresis
Terminology
Uosm=
Total
(ml)
Osm
clearance (Cosm)
ml/min
= urine osm * urine volume (ml)
posm * 1440
FE osm = (Cosm/Ccr)*100
Water diuresis
Check
diabetes insipidus
serum sodium
polydipsia
8-12 serum sodium and urine osmole
polydipsia
Water diuresis
nephrogenic DI central DI
Clinical
water deprivation test or vasopresin response
test
Common cause of DI
Central
DI
Nephrogenic DI
Hypercalcemia
Lithium
Hypokalemia
(chronic)
Chronic kidney disease
Chronic renal tubulo-intersitial disease
Solute diuresis
electrolyte
and non-electrolyte
Solute diuresis
2 x (Una+ +UK+)
Uosm
< 0.4
non electrolyte
electrolyte
> 0.6
Plasma vasopressin
Diagnosis
pg/ml
>4
Normal
>4
Primary
polydipsia
1-3
<1
>4
Partial
Central DI
Complete
Central DI
Nepgrogenic DI