Normally, when your kidneys create urine, they reabsorb all of the sugar and direct it back to the bloodstream. With type 1 diabetes, excess glucose ends up in the urine, where it pulls more water and results in more urine. As we mentioned above the dehydration that results from polyuria, or excessive urination, can lead to kidney problems—or even diabetic ketoacidosis, which can be life-threatening.
We value your privacy. It is characterized by dryness of the mouth, eyes, and other mucous membranes due Past medical history should be reviewed for conditions associated with polyuria, including diabetes mellitus Diabetes Mellitus DM Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia.
It is caused by homozygous inheritance of genes for hemoglobin Hb S. The lungs and lymphatic system are most often affected, but These proteins may accumulate locally Principal causes include hyperparathyroidism, vitamin A family history of polyuria and excessive water drinking should be noted.
Drug history should note use of any drugs associated with nephrogenic diabetes insipidus Nephrogenic Diabetes Insipidus Nephrogenic diabetes insipidus NDI is an inability to concentrate urine due to impaired renal tubule response to vasopressin ADH , which leads to excretion of large amounts of dilute urine The general examination should note signs of obesity as a risk factor for type 2 diabetes mellitus Diabetes Mellitus DM Diabetes mellitus is impaired insulin secretion and variable degrees of peripheral insulin resistance leading to hyperglycemia.
Skin examination should note the presence of any hyperpigmented or hypopigmented lesions, ulcers, or subcutaneous nodules that may suggest sarcoidosis. Comprehensive neurologic examination should note any focal deficits that suggest an underlying neurologic insult and assess mental status for indications of a thought disorder. Volume status should be assessed.
Extremities should be examined for edema. History can often distinguish polyuria from frequency, but rarely a hour urine collection may be needed.
Diabetes insipidus Central Diabetes Insipidus Diabetes insipidus results from a deficiency of vasopressin antidiuretic hormone [ADH] due to a hypothalamic-pituitary disorder central diabetes insipidus or from resistance of the kidneys Abrupt onset of polyuria at a precise time suggests central diabetes insipidus, as does preference for extremely cold or iced water. Onset during the first few years of life is typically related to inherited central or nephrogenic diabetes insipidus Nephrogenic Diabetes Insipidus Nephrogenic diabetes insipidus NDI is an inability to concentrate urine due to impaired renal tubule response to vasopressin ADH , which leads to excretion of large amounts of dilute urine Polyuria caused by solute diuresis is suggested by a history of diabetes mellitus.
Psychogenic polydipsia is more common in patients with a history of a psychiatric disorder primarily bipolar disorder Bipolar Disorders Bipolar disorders are characterized by episodes of mania and depression, which may alternate, although many patients have a predominance of one or the other.
Exact cause is unknown, but heredity Once excess urine output has been verified by history or measurements, serum or fingerstick glucose determination should be done to rule out uncontrolled diabetes.
The most common cause is Urine is created in the kidneys with water and solids filtered from the bloodstream. Adult should generally void no more than 2. Polyuria occurs when an adult produces more than 3 liters, regardless of how often he or she urinates. The prevalence of polyuria is not very well documented. Nocturia has been studied more than polyuria.
There is evidence suggesting that nocturia and polyuria are both more common in older patients. Polyuria literally translates to "urinating too much" and may be the only symptom one experiences. However, depending on the cause, there are other symptoms that can accompany polyuria. When the cause is either diabetes insipidus or diabetes mellitus, polyuria is usually coupled with excessive thirst polydipsia. Frequent urination, especially at night nocturia , is often associated with polyuria, but it doesn't have to be.
There are myriad causes of polyuria, which range from being as simple as drinking too much water to a serious health complication like kidney failure. The following causes of polyuria are the most common.
Diabetes mellitus is a condition caused by the body's inability to adequately control blood sugar, either because it is unable to properly manufacture insulin or a resistance to the effects of insulin.
Diabetes mellitus leads to higher osmolarity in the bloodstream because of increased sugar levels. Think of the blood as a bit syrupy in a patient with diabetes mellitus. The kidneys must work to filter out the increased sugar by creating more urine.
Diabetes insipidus is completely different from diabetes mellitus and doesn't have anything to do with blood glucose levels. Instead, diabetes insipidus is related to polyuria directly in its connection to arginine vasopressin AVP , an antidiuretic hormone.
Central diabetes insipidus is caused by a lack of arginine vasopressin secretion due to a neurological condition. Nephrogenic diabetes insipidus is due to failure of the kidney to respond to AVP.
Central diabetes insipidus can be acquired from a medical or traumatic brain injury. Nephrogenic diabetes insipidus is usually inherited. Certain medications are designed to increase urination to treat conditions like congestive heart failure and high blood pressure.
Those medications can lead to polyuria if the dosages are not correct. Lithium is a medication used to control mood disorders. It is almost entirely excreted from the body in urine and can have a profound effect on the kidneys in patients who take it regularly. Lithium can cause polyuria and polydipsia as a result of lithium-induced nephrogenic diabetes insipidus.
If lithium is discontinued early enough once the polyuria is noticed, the symptoms can be reversed without any long-term damage. However, if polyuria is present and lithium is not discontinued, irreversible damage to the kidneys can cause permanent polyuria.
Polyuria in sickle cell disease results from a similar mechanism, as sickling in the vasa recta interferes with the countercurrent exchange mechanisms In some cases, polyuria can be caused by a combination of both mechanisms. The linear relationship between solute excretion and urine output described above is strongly influenced by ADH. In the setting of a solute diuresis, absence or deficiency of ADH can augment the degree of polyuria quite dramatically.
Polyuria has a broad range of causes and can be a diagnostic challenge for clinicians. Understanding the pathophysiology that underpins the different mechanisms of polyuria is essential to appropriate workup, diagnosis, and treatment of this condition. If this is a complaint, the first step is to quantitate the hour urine volume. We recommend referral to endocrinology when there is evidence of hypothalamic or pituitary disease, when a water deprivation test is required, or in cases where the diagnosis is unclear.
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