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Lectures > Approach to polyuria/polydipsia > Flashcards

Approach to polyuria/polydipsia Flashcards

1
Q

What specific gravity levels suggest hyposthenuria?

A

1.000-1.008

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2
Q

What levels are isosthenuria?

A

1.008-1.012

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3
Q

What levels are minimally concentrated urine?

A

1.013-1.030

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4
Q

What levels are hypersthenuria?

A

1.030-1.055

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5
Q

What are the main causes of polyuria/polydipsia in dogs?

A
  • diabetes mellitus
  • renal failure
  • hyperadrenocorticism
  • hypercalcaemia
  • neoplasia
  • pyogenic foci
  • hypoadrenocorticism
  • pyschogenic polydipsia
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6
Q

What are common causes of polyuria/polydipsia in the cat?

A
  • renal failure
  • hyperthyroidism
  • diabetes mellitus
  • pyogenic foci
  • liver failure
  • neoplasia
  • hypercalcaemia
  • diabetes inspidius
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7
Q

what would state a dog is polydipsic?

A

drinking more than 80ml/kg/day of water

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8
Q

What questions should be asked during a clinical history taking?

A 
behaviour- lethargy, episodic collapse?
change in appetite?
alopecia? comedomes?
vomiting? diarrhoea? discharges?
medical history of drugs?urinary obstruction?
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9
Q

What should be checked in a clinical exam?

A 
full exam
lymph nodes
skin
abdominal pain
rectal exam
thyroid palpation in cats
purulent discharges
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10
Q

What are causes of hyposthenuria (SG of 1.001-1.007)?

A

Loss of concentration gradient- diuresis, hypoadrenocorticism
Loss of ADH or its receptors- primary diabetes insipidus
Antagonism of ADH- hyperadrenocorticism
Excessive water consumption
Kidneys are functioning

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11
Q

What are causes of isothenuria (SG of 1.008-1.012)

A

Loss of nephrons- renal failure

Normal

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12
Q

What are causes of hypersthenuria (1.030+)?

A

decreased renal perfusion

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13
Q

A specific gravity greater than what excludes PU/PD?

A

1.035

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14
Q

A specific gravity range of what excludes diabetes inspidius?

A

1.008-1.035

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15
Q

What is decreased urea suggestive of?

A

liver disease

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16
Q

What is increased urea suggestive of?

A

GI haemorrhage

17
Q

What is hypokalaemia suggestive of?

A

renal failure, ketoacidosis

18
Q

What is hyperphosphataemia suggestive of?

A

renal failure

19
Q

What is hypophosphataemia suggestive of?

A

ketoacidosis

20
Q

What is hyperglobulinaemia suggestive of?

A

inflamammatory process

21
Q

If all diseases are ruled out from haematology what could it be?

A

cushings disease

22
Q

Describe the 2 central causes of primary diabetes insipidus

A

Central (DDAVP responsive)- neoplasia, congenital, trauma, inflammation
Nephrogenic (not DDAVP responsive)- lack of ADH receptors, juvenile nephropathies

23
Q

Describe water deprivation test method 1

A

Not common test, used when everything else is ruled out
Need to check kidneys are functioning first
Method 1:
Phase 1- water restriction, 2x maintenance for one day
Phase 2- water deprivation, empty bladder and weigh every 2 hrs, check urea and creatinine every 2 hrs, preserve urine and plasma samples
Requires hospitalisation and close monitoring
Typically lasts around 6 hrs

24
Q

Describe water deprivation test method 2

A 
Phase 3:
DDAVP response
2-4mg DDAVP IV
Monitor urine S.G for 2-4 hrs
Gradually re-introduce water
25
Q

What can the water deprivation test suggest?

A

When the water is withheld and the urine becomes concentrated then dog has normal pituitary function- psychogenic polydipsia
When urine isn’t concentrated, dog becomes dehydration and still doesn’t respond to DDAVP- nephrogenic diabetes insipidus
Water is deprived, dog is dehydrated, given DDAVP and urine now becomes concentrated- central diabetes inspidius

26
Q

What would be the next diagnostic tool for central diabetes insipidus?

A

CT or MRI
Look for tumours, haemorrhage, trauma
Nephrogenic diabetes inspididus - renal biopsy, congenital nephropathies

27
Q

In what situation is pyschogenic polydispsia common in?

A
  1. Typically young dogs housed in groups sharing a water bowl
  2. Can be owner induced
28
Q

Describe the overall assessment of a polyuria/polydipsia patient

A

History and physical exam- tells of drugs and post obstruction diluresis
Urinalysis- can exclude diabetes mellitus
Routine biochemistry- excludes diabetes mellitus, hypokalaemia, hypercalcaemia, hypoadrenocorticism, chronic renal failure, liver disease
Routine haematology- excludes cushings disease
Exclude cushings disease- dexamethasone suppression test
Diagnostic imaging- excludes pyogenic focus and neoplasia
Water deprivation test- excludes diabetes insipidus, psychogenic polydipsia

Lectures (25 decks)

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