Diabetes insipidus during pregnancy

Ananthakrishnan, Sonia

doi:10.1016/j.beem.2016.02.005

Cited by 37 publications

(35 citation statements)

References 55 publications

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“…Gestational diabetes mellitus (GDM) is diagnosed as having hyperglycaemia during pregnancy in a woman who has not yet had diabetes mellitus, with values corresponding to the diagnosis of diabetes mellitus or any of the conditions of glucose intolerance [17]. During pregnancy, especially in the 2nd and 3rd trimesters, there is a physiological decrease in insulin sensitivity and a worsening of glucose tolerance [18].…”

Section: Gestational Diabetesmentioning

confidence: 99%

Emergency medicine point of view on epidemiology of diabetes and diabetes-related complications

Szalast

Szarpak

2020

Disaster Emerg Med J

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INTRODUCTION: Despite centuries of research and clinical work, the diagnosis of diabetes was still treated as a quick death sentence at the beginning of the 20th century. Unfortunately, the number of patients with diabetes is increasing every year. Type 2 diabetes is increasingly common among young people: children and adolescents. The article discusses the type of diabetes and the importance of rapid diagnosis and management. Type 1 diabetes, type 2 diabetes, latent autoimmune diabetes in adults, monogenic diabetes, gestational diabetes were analysed. Life-threatening conditions resulting from complications of diabetes including diabetic ketoacidosis, hyperglycaemic-hyperosmolar state, hypoglycaemia, lactic acidosis were discussed, and the first-line emergency treatment were analysed. The life-threatening complications of diabetes and rescue procedures in these conditions were discussed in detail. CONCLUSIONS: Due to the frequency of life-threatening complications, diabetes is a heavy burden on the medical staff. Adequate diagnosis and implementation of appropriate treatment significantly improve the patient's condition.

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Section: Gestational Diabetesmentioning

confidence: 99%

Emergency medicine point of view on epidemiology of diabetes and diabetes-related complications

Szalast

Szarpak

2020

Disaster Emerg Med J

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“…19 DI occurring during pregnancy is often transient and develops due to accelerated degradation of AVP by increased activity of placental vasopressinase. 20 Congenital forms of central DI are uncommon, mostly inherited in an autosomal-dominant fashion, and account for 1-5% of all causes of central DI. 21 So far, several different mutations located in the coding region of the AVP precursor gene have been reported.…”

Section: Central DImentioning

confidence: 99%

Polyuria‐polydipsia syndrome: a diagnostic challenge

Nigro

Grossmann

Chiang

et al. 2018

Internal Medicine Journal

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The main determinants for the maintenance of water homeostasis are the hormone arginine vasopressin (AVP) and thirst. Disturbances in these regulatory mechanisms can lead to polyuria-polydipsia syndrome, which comprises of three different conditions: central diabetes insipidus (DI) due to insufficient secretion of AVP, nephrogenic DI caused by renal insensitivity to AVP action and primary polydipsia due to excessive fluid intake and consequent physiological suppression of AVP. It is crucial to determine the exact diagnosis because treatment strategies vary substantially. To differentiate between the causes of the polyuria-polydipsia syndrome, a water deprivation test combined with desmopressin administration is the diagnostic 'gold standard'. Thereby, AVP activity is indirectly evaluated through the measurement of urine osmolality after prolonged dehydration. However, this test has several limitations and may fail to distinguish precisely between patients with primary polydipsia and mild forms of central and nephrogenic DI. The direct measurement of AVP during the water deprivation test, which was reported in the 1980s, has not been widely adopted due to availability, assay issues and diagnostic performance. Recently, copeptin, the c-terminal portion of the larger precursor peptide of AVP, has been evaluated in the setting of polyuria-polydipsia syndrome and appears to be a useful candidate biomarker for the differential diagnosis. A standardised method for the water deprivation test is presented as part of a joint initiative of the Endocrine Society of Australia, the Australasian Association of Clinical Biochemists and the Royal College of Pathologists of Australasia to harmonise dynamic endocrine tests across Australia.

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“…При появлении симптомов НД во время беременности рекомендуется проведение полного спектра диагностики (см. рекомендации 1-8) [32,33].…”

Section: центральный несахарный диабет при беременностиunclassified

Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults

Dedov¹,

Melnichenko²,

Pigarova³

et al. 2018

Obes. metabol.

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We do not recommend population screening for diabetes insipidus (DI) (B3). We recommend to perform diagnostic testing for central diabetes insipidus (CDI) in patients who underwent neurosurgery, after skull and brain trauma, subarchnoid hemorrhage (B3). We recommend excluding thirst impairment during all stages of diagnostic assessment (С3). We recommend excluding DI in cases of persistent hypotonic polyuria: excretion of more than 3 L. or more than 40 mL/kg of urine daily; urine osmolality less than 300 mOsm/kg or urinary specific gravity less than 1004 g/L in all urine samples or during Zimnitsky test (В3). After hypotonic polyuria is confirmed, we recommend excluding of the main causes of nephrogenic diabetes insipidus (NDI) (B3). We recommend simultaneous measurement of urine osmolality and blood osmolality/sodium level in order to confirm DI. Blood hyperosmolality (more than 300 mOsm/kg) and/or hypernatremia with low urine osmolality (less than 300 mOsm/kg) confirms DI (B2). If testing does not reveal these findings, we recommend performing a fluid deprivation test to exclude primary polydipsia (PP) (B2). Desmopressin test is recommended to distinguish CDI and NDI (B2). In cases of CDI we recommend to perform head MRI with contrast (B3). In cases of NDI we recommend assessing renal structure and function and possible electrolyte disturbances (C3). In cases of PP we recommend to refer a patient to psychiatrist (B3). We recommend treating CDI with synthetic vasopressin analogue – desmopressin (B1). We recommend an individual approach in choosing desmopressin dosage form (B2). As the initial dose is difficult to predict when starting desmopressin treatment, we recommend titrating the dosage using two approaches: “the average dose” and “as required” (C4). We recommend educating the patients to ensure knowledge of the features of various desmopressin dosage forms (C4). To decrease the risk of water intoxication, we recommend educating the patients to the water intake regimen adherence (С4). When CDI is accompanied by thirst impairment, we recommend titrating the dose in a clinical setting, with assessment of blood sodium, bodyweight and/or urine volume (C4).

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Diabetes insipidus during pregnancy

Cited by 37 publications

References 55 publications

Emergency medicine point of view on epidemiology of diabetes and diabetes-related complications

Emergency medicine point of view on epidemiology of diabetes and diabetes-related complications

Polyuria‐polydipsia syndrome: a diagnostic challenge

Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults

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