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.
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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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BANGKOK, THAILAND – Bangkok has a huge variety of delicious international food including amazing Indian restaurants. Today we’re going on a food tour to eat some of the best South Indian food in Bangkok – from small canteens to fine dining, these are some of the best South Indian restaurants in Bangkok.
Sri Ganesha Restaurant (https://goo.gl/maps/5KNhqQfwJ35rwJdz5), Prices – About 100 – 150 THB per plate. Located on the ground floor of Sukhumvit Suites, Sri Ganesha Restaurant is a vegetarian South Indian restaurant that specializes in things like idlis, dosas, and uthappam. Their dishes are fantastic and the chutneys are superb.
Sugam Restaurant (https://g.page/Sugamrestaurant?share), Price – 189 THB per person (.78 USD) – Probably my favorite Indian restaurant in all of Bangkok is Sugam Restaurant which serves pure vegetarian Tamil Nadu style South Indian food. They serve everyday, but on Saturdays they have an 18 food varieties thali served on a banana leaf. It was amazing to hang out with Mr. Vijay and his family, and to eat epic South Indian food.
JHOL Coastal Indian Cuisine (https://g.page/Jholbkk?share), Price – About 1,500 – 2,500 THB per person – Finally to complete this best South Indian food tour in Bangkok I went to Jhol, an upper end modern Indian restaurant serving coastal Indian food – mostly South Indian. The quality of the ingredients and the balance of spice and masalas is outstanding – another one of the best restaurants in Bangkok.
And that completes the best of South Indian food restaurants in Bangkok!
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B.S., Kinesiology & Exercise Science, Illinois State University, 1994
M.S., Kinesiology & Exercise Science, Illinois State University, 1996
M.D., Des Moines University, 2002
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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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