Loss of thirst

Introduction Secondary diabetes insipidus is caused by the hypothalamic pituitary tumor, brain trauma, surgery, inflammation, and the thirst is lost when the lesion involves the thirst center of the hypothalamus. Loss of thirst can be seen in hypertension, renal tubular acidosis, anemia, urinary tract obstruction, and Fanconi syndrome.

Cause

Common secondary causes are:

1. Eating disorders, excessive drinking water, low sodium intake, and low protein intake.

2. Chronic renal failure, decreased concentrating function.

3. Electrolyte disorders, hypokalemia, high blood calcium.

4. Diuresis after urinary tract obstruction is relieved.

5. Acute renal failure and diuretic period.

6. Paroxysmal hypertension.

7. Systemic diseases sickle cell anemia, Sjogren's syndrome, amyloidosis, Fanconi syndrome, sarcoidosis (sarcoidosis), renal tubular acidosis, light chain nephropathy.

8. Drug lithium, dexamethasone (nor-methamphein), colchicine, vinblastine, methoxyfluoride, anesthetic, toluenesulfonamide, chlorpropamide, amphotericin B, gentamicin, furose Rice, ethenic acid, osmotic diuretics, angiographic agents, cyclophosphamide, etc.

an examination

Related inspection

Glucagon blood sugar

1. Urine examination has a significant increase in urine volume per day, and is accompanied by a decrease in urine specific gravity (1.001 to 1.005) and a urine osmotic pressure of 150 to 180 mmol/L. The vasopressin test has no response ("incomplete phenotype" may have partial response).

2. The blood test is concentrated due to blood concentration, the plasma osmotic pressure is increased, and the extracellular fluid is hyperosmotic. When the plasma osmotic pressure is >280mOsm/L, the hemoglobin and hematocrit are increased, the blood sodium and blood chlorine are increased, and the blood sodium is >150mmol/L. The late urea hydrogen and creatinine can be increased.

3. Exogenous injection of vasopressin is ineffective, and urine cAMP fluid does not increase. The hypertonic saline test has no response, and the water-free test can be used to distinguish between severe, mental, and renal diabetes insipidus.

Regular examinations such as imaging and B-ultrasound can be found to have too much amniotic fluid at birth. Intravenous pyelography revealed hydronephrosis, ureteral hydrops, and bladder dilatation. Brain CT examination can detect calcification of brain tissue, and EEG can detect abnormal waves or epileptic discharges.

Differential diagnosis

Differential diagnosis of loss of thirst:

1, polydipsia and polydipsia: diabetes insipidus often accompanied by polydipsia and polydipsia, or fever, dehydration, or even convulsions. Diabetes insipidus is caused by the lack of antidiuretic hormone (ie, arginine vasopressin, AVP for short) and the dysfunction of renal tubular reabsorption of water, which causes polyuria, polydipsia, polydipsia and low specific gravity urine. a disease. The disease is caused by lesions in the hypothalamic-neuronal pituitary, but some cases have no obvious cause. Diabetes insipidus can occur at any age, but it is more common in young people.

2, the mouth is thirsty and unbearable: mouth thirsty and unbearable performance is mainly thirsty, want to drink water, the symptoms are slightly improved after drinking, but soon thirsty as ever.

3. Drinking more: People with diabetes can't convert the sugars absorbed by the human body from food into liver glycogen and muscle glycogen at the level of normal people. The sugar they absorb is broken down into glucose after the body's sugar cycle. It can no longer be used, and the kidneys used to filter the impurities in the blood will absorb the glucose in the blood into the urine, then transfer it to the bladder and then discharge it. The osmotic pressure of the urine is high, and the water is discharged more. Of course, when the body needs less water, it is thirsty, so drink more.

1. Urine examination has a significant increase in urine volume per day, and is accompanied by a decrease in urine specific gravity (1.001 to 1.005) and a urine osmotic pressure of 150 to 180 mmol/L. The vasopressin test has no response ("incomplete phenotype" may have partial response).

2. The blood test is concentrated due to blood concentration, the plasma osmotic pressure is increased, and the extracellular fluid is hyperosmotic. When the plasma osmotic pressure is >280mOsm/L, the hemoglobin and hematocrit are increased, the blood sodium and blood chlorine are increased, and the blood sodium is >150mmol/L. The late urea hydrogen and creatinine can be increased.

3. Exogenous injection of vasopressin is ineffective, and urine cAMP fluid does not increase. The hypertonic saline test has no response, and the water-free test can be used to distinguish between severe, mental, and renal diabetes insipidus.

Regular examinations such as imaging and B-ultrasound can be found to have too much amniotic fluid at birth. Intravenous pyelography revealed hydronephrosis, ureteral hydrops, and bladder dilatation. Brain CT examination can detect calcification of brain tissue, and EEG can detect abnormal waves or epileptic discharges.

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