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polyuria is one of most common symptoms in CKD / DM / DI

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Polyuria occurs as a result of an osmotic diuresis. This is a diuresis that occurs for osmotic reasons. Diuresis means an abnormally large volume of urine is produced. When the level of glucose in the blood increases there is an equivalent increase in the concentration of glucose in glomerular filtrate. The quantity of glucose the renal tubules are able to reabsorb is limited. In health, when blood glucose levels are normal, all of the glucose in the filtrate is reabsorbed; this means physiologically there is no glucose at all in urine. However, when glucose glomerular filtrate levels are abnormally high it cannot all be reabsorbed. This will result in glucose passing straight through the tubule into the urine.
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https://www.amazon.com/Mosbys-Medical-Dictionary-Mosby/dp/0323414257?&_encoding=UTF8&tag=maturecolors2-20

Polyuria

Polyuria: The excessive passage of urine (at least 2.5 liters per day for an adult) resulting in profuse urination and urinary frequency (the need to urinate frequently). Polyuria is a classic sign of diabetes mellitus that is under poor control or is not yet under treatment. Polyuria occurs in some other conditions such as: Certain drugs such as the mood stabilizer lithium (Lithobid, Eskalith) and the antibiotic demeclocycline (Declomycin) can also lead to polyuria.

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A discussion of the definition, etiologies, work-up, and diagnosis of polyuria, including a discussion of the water deprivation test to diagnose diabetes insipidus. The distinction between polyuria, urinary frequency, and nocturia is also discussed.

medskl.com is a free, global medical education site (FOAMEd) covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations.

Endocrinology – Polyuria: The Bottom Line
Whiteboard Animation Transcript
with Jeannette Goguen, MD
https://medskl.com/Module/Index/polyuria

Investigating polyuria requires an organized approach:

Step 1: First, confirm that the patient actually is polyuric (i.e., make more than 3 liters day), and doesn’t just have urinary frequency with a normal urine volume. Are they drinking more than 3 liters a day? If they are in steady state, fluid in = fluid out. They should have nocturia as well.

Step 2: Next, find out why they are drinking so much. If they say “because, it’s good for me”, then tell them to reduce their fluid intake, and see if the urine volume drops.

Step 3: With polyuria confirmed, it is time to look for a reason why.

The commonest reason is an osmotic diuresis from poorly controlled diabetes mellitus. Do they have known diabetes mellitus? Risk factors for diabetes mellitus? Other symptoms like weight loss and polyphagia? Otherwise, are they on a diuretic? In the hospitalized patient, consider mannitol use, the urea load from TPN and the normal clearing of excess administered intravenous fluids.

Next consider a water diuresis. There are 3 causes for water diuresis:

• Psychogenic polydipsia is when the patient drinks excessively and is often associated with psychosis.
• Next, in Diabetes insipidus or “DI”, the high urine output is driving the drinking. There are two forms of DI: central with loss of ADH secretion from the posterior pituitary from things like pituitary mass or following pituitary surgery OR
• Nephrogenic DI, where their kidneys do not respond properly to ADH – a situation that may be congenital or linked to Lithium use, hypercalcemia, and hypokalemia.

Unless the diagnosis is obvious like diabetes mellitus, hypercalcemia, hypokalemia, or after pituitary surgery, you may not be able to sort out why the patient has polyuria, and you will need to refer them to an endocrinologist to do a water deprivation test, in a controlled setting.

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If you have diabetes, must you really avoid carbohydrates? Is consuming more fruits and vegetables always healthy? What is the difference between plant-based and animal-based carbohydrates? Find out in this video!

Please consult your dietitian for a targeted meal plan.

To learn more about diabetes and coping with it, visit HealthXchange.sg https://www.healthxchange.sg/diabetes
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Can a person be “cured” of Type 2 Diabetes? Dr. Sarah Hallberg provides compelling evidence that it can, and the solution is simpler than you might think.

Dr. Sarah Hallberg is the Medical Director of the Medically Supervised Weight Loss Program at IU Health Arnett, a program she created. She is board certified in both obesity medicine and internal medicine and has a Master’s Degree in Exercise Physiology. She has recently created what is only the second non-surgical weight loss rotation in the country for medical students. Her program has consistently exceeded national benchmarks for weight loss, and has been highly successful in reversing diabetes and other metabolic diseases. Dr. Hallberg is also the co-author of www.fitteru.us, a blog about health and wellness.

B.S., Kinesiology & Exercise Science, Illinois State University, 1994

M.S., Kinesiology & Exercise Science, Illinois State University, 1996

M.D., Des Moines University, 2002

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx
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Diabetes mellitus pathophysiology and nursing nclex lecture review on diabetes type 1 and diabetes type 2. Diabetes mellitus is where a patient has insufficient amounts of insulin to use the blood glucose in the body. Therefore, the patient will experience extreme hyperglycemica. In this lecture, I highlight the key players in diabetes mellitus, causes, different types of diabetes (type 1, type 2, and gestational), complications, and nursing assessment of the diabetic patient.

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What is diabetes mellitus? Diabetes mellitus is when there’s too much glucose, a type of sugar, in the blood. Diabetes mellitus can be split into type 1, type 2, as well as a couple other subtypes, including gestational diabetes and drug-induced diabetes.

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Diabetes refers to a group of conditions characterized by a high level of blood glucose, commonly referred to as blood sugar. Too much sugar in the blood can cause serious, sometimes life-threatening health problems.
There are two types of chronic diabetic conditions: type 1 diabetes and type 2 diabetes. Pregnant women may acquire a transient form of the disease called “gestational diabetes” which usually resolves after the birth of baby. Pre-diabetes is when the blood sugar level is at the borderline: higher than normal, but lower than in diabetics. Prediabetes may or may not progress to diabetes.
During food digestion, carbohydrates – or carb – break down into glucose which is carried by the bloodstream to various organs of the body. Here, it is either consumed as an energy source – in muscles for example – or is stored for later use in the liver. Insulin is a hormone produced by beta cells of the pancreas and is necessary for glucose intake by target cells. In other words, when insulin is deficient, muscle or liver cells are unable to use or store glucose, and as a result, glucose accumulates in the blood.
In healthy people, beta cells of the pancreas produce insulin; insulin binds to its receptor on target cells and induces glucose intake.
In type 1 diabetes, beta cells of the pancreas are destroyed by the immune system by mistake. The reason why this happens is unclear, but genetic factors are believed to play a major role. Insulin production is reduced; less insulin binds to its receptor on target cells; less glucose is taken into the cells, more glucose stays in the blood. Type 1 is characterized by early onset, symptoms commonly start suddenly and before the age of 20. Type 1 diabetes is normally managed with insulin injection. Type 1 diabetics are therefore “insulin dependent”.
In type 2 diabetes, the pancreas produces enough insulin but something goes wrong either with receptor binding or insulin signaling inside the target cells. The cells are not responsive to insulin and therefore cannot import glucose; glucose stays in the blood. In other words, type 2 diabetics are “insulin resistant”. Here again, genetic factors predispose susceptibility to the disease, but it is believed that lifestyle plays a very important role in type 2. Typically, obesity, inactive lifestyle, and unhealthy diet are associated with higher risk of type 2 diabetes. Type 2 is characterized by adult onset; symptoms usually appear gradually and start after the age of 30. Type 2 diabetes accounts for about 80 to 90% of all diabetics. Management focuses on weight loss and includes a low-carb diet.
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