Polyuria

Question 1

Causes of polyuria

Answer 1

Diabetes
Diuretics
Heart failure
Hyperthyroidism
Hypercalcaemia
Diabetes insipidus (either type) can be induced by renal failure

Question 2

Features of diabetes

Answer 2

Weight loss
Fatigue
Polyuria/polydipsia
Recurrent infection

Question 3

Lower urinary tract symptoms

Answer 3

Terminal dribbling
Hesitancy
Frequency
Incomplete voiding
Urgency

Question 4

Low urine osmolality implies…

Answer 4

Unable to concentrate

Either drinking loads or unable to get the water back (diabetes insipidus)

Question 5

High urine osmolality with high volume implies…

Answer 5

Diabetes (glucose staying in the urine and bring fluid out with it)

Question 6

Serum osmolality low, urine osmolality low

Answer 6

Primary polydipsia

Question 7

In diabetes insipidus what are you unable to do?

Answer 7

Retain water from the collecting ducts
Can’t concentrate urine
EIther cranial (no vasopressin) or nephrogenic (doesn’t respond to vasopressin)

Question 8

Causes of cranial diabetes insipidus

Answer 8

Trauma 
Pituitary tumours
Metastases
Surgery
Meningitis

Question 9

Causes of nephrogenic diabetes insipidus

Answer 9

Follows renal damage (hypokalaemia, drugs, pyelonephritis)

Also hypercalcaemia

Question 10

Which test do you do to determine if cranial or nephrogenic?

Answer 10

Water deprivation test
Give desmopressin and see if it concentrates their urine! (means it was cranial, because they didn’t have any vasopressin)

Question 11

Medication for diabetes insipidus

Answer 11

Desmopressin

Question 12

Medication for nephrogenic diabetes insipidus

Answer 12

Thiazide diuretic

Question 13

Pathology of type 1 diabetes

Answer 13

Reduction in production of insulin due to reduction in pancreatic beta cells

Question 14

Antibodies in T1DM

Answer 14

Anti GAD autoantibodies

Question 15

Diagnostic criteria fo diabetes

Answer 15

Fasting BM >7

Plasma glucose >11.1 2hr after 75g of glucose

Question 16

What should Type 1 diabetics do when they are ill?

Answer 16

Increase insulin dose, because the corticosteroid desensitises a bit from the insulin
Make sure to keep a close eye on capillary glucose

Question 17

What investigations do you need with calcium?

Answer 17

PTH
Phosphate
ALP

Question 18

CRAB Sx from which pathology?

Answer 18

Multiple myeloma

Question 19

Hyponatraemia and excess drinking

Answer 19

Psychogenic polydipsia

Question 20

Long term complications of diabetes

Answer 20

Microvascular
Retinopathy
Neuropathy (usually glove and stocking distribution and autonomic dysfunction)
Nephropathy

Macrovascular
Cardiovascular disease
Peripheral vascular disease
IHD

Question 21

HHS is…

Answer 21

Hyperosmotic hyperglycaemic state

No ketones in the urine

Question 22

What can precipitate HHS?

Answer 22

Illness

Poor compliance with treatment (causing glucose to go REALLY HIGH)

Question 23

Pathology of HHS

Answer 23

Blood filled with glucose (hyperglycaemia), very thick

Question 24

Where is vasopressin produced?

Answer 24

Posterior pituitary

Question 25

What stimulates vasopressin release?

Answer 25

Rise in sodium concentration (you are becoming dehydrated)

Question 26

What do gliptins do?

Answer 26

Inhibit DPP4, an incretin, which normally stimulates insulin release

Question 27

What do sulphonylureas do?

Answer 27

Stimulate insulin release

Question 28

What does metformin do?

Answer 28

Reduces glucose production from liver and stimulates glucose uptake from the blood (sensitises insulin)

Question 29

What does acarbose do?

Answer 29

Reduce food breakdown, slows down glucose release after meals

Question 30

Side effect of acarbose

Answer 30

Flatulence

Question 31

Whats the big risk of HHS?

Answer 31

Thrombotic events

Question 32

What do you need to give in HHS?

Answer 32

Fluid

Anti-coagulation