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Transcript
Internal Medicine
2.
Water deprivation test: started in the morning by weighing the patient, obtaining venous
blood to determine electrolyte concentrations and osmolality, and measuring urinary
osmolality.
Fluid intake is withheld, and voided urine is collected hourly and its osmolality is
measured. Dehydration is continued until
•
Orthostatic hypotension and postural tachycardia appear,
•
5% or more of the initial body weight has been lost, or
•
The urinary concentration does not increase by more than 30 mOsm/L in
sequentially voided specimens for 3 hrs.
At this point, serum electrolytes and osmolality are again determined, and
Five (5 U) of aqueous vasopressin or 2 µg of desmopression is then injected SC.
Urine osmolality is measured 1 hr later.
Table VII-4- 2 Interpretations of Water deprivation test
Disorder
Urinary osmolality in
Response to Vasopressin
response to water
injection
deprivation
Normal response
Central DI
Urinary osmolality increases
No further increment in urine
> 280 mOsm/kg
osmolality
The urinary osmolality does Urinary osmolality increases
not increase
Nephrogenic DI
The urinary osmolality does The urinary osmolality does
not increase
not increase
3. Measurement of circulating ADH concentrations by radioimmunoassay
Differential diagnosis:
•
Compulsive (psychogenic) water drinking
•
Nephrogenic diabetes insipidus.
Treatment:
1. Hormonal therapy:
489