As a pediatrician, you face many cases of polyuria in your clinic. Watch this video with us and you will know how to deal with polyuria cases.
When will you be able to depend only on urine osmolality, and when will you need water deprivation test?
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Nocturia is a common urological problem with a high prevalence (up to 60%) especially in elderly patients (1). The underlying causes for nocturia are various, such as conditions causing sleeping disorders, bladder storage problems, and nocturnal polyuria. Patients with nocturnal polyuria have an increased production of urine during nighttime (i.e. one third or more of the total volume of urine produced in 24-hours) (2). Nocturnal polyuria may be present in patients with obstructive sleep apnea (OSA) and treatment with continuous positive airway pressure (CPAP) reduces nighttime frequency and nocturnal voided volume in patients with OSA (3).
In this study, we examined the amount of patients with nocturnal polyuria that suffer from OSA.
Subsequently, we offered patients with confirmed OSA treatment with CPAP, and analyzed the effect on episodes of nocturia and the nocturnal polyuria index (NPi= voided volume during night time/voided volume in 24 hours*100).
Read the full abstract text here: https://www.ics.org/2020/abstract/82 Video Rating: / 5
Are you confused about what polyuria, polydipsia and polyphagia mean, and what you need to know about them in nursing school?
In this video, I’ll break down exactly what polyuria, polydipsia and polyphagia are, and how they relate to the med-surg disorders you’re learning about during nursing school.
Here’s a breakdown of what we’ll talk about:
Polyuria means excessive urination, polydipsia means excessive thirst, and polyphagia means excessive hunger.
These 3 symptoms are sometimes referred to as the “3 P’s” and probably the most common disorder you’ll hear them associated with is diabetes.
During diabetes, the body can’t use glucose for energy, so it uses fat instead. And this leads to a lot of extra glucose in the blood (hyperglycemia).
So polyuria, polydipsia, and polyphagia occur as compensatory mechanisms to try to reduce the blood sugar level.
In this video, I’ll go deeper into this concept of how the body uses polyuria, polydipsia, and polyphagia to reduce blood sugar levels.
I hope you enjoy it! 🙂
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Explains how Polyuria, Polyphagia, Polydipsia occurs in Diabetes mellitus. Also explains about glucostatic theory, satiety center, osmotic diuresis, thirst center activation
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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. Video Rating: / 5
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.
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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.
