Published on 24/06/2015 by admin Filed under Last modified 24/06/2015 This article have been viewed 239 times

Chapter 46Polyuria and Polydipsia (Case 38) Kavita Iyengar MD Case: The patient is a 68-year-old woman with a medical history of hypertension, hyperlipidemia, and obesity. She presents to the outpatient office because for the last few weeks she has been more tired than usual and feels that she has been drinking more water. She has also been going to the bathroom more frequently, particularly at night. In addition, she has blurry vision and headaches. Her husband is also your patient. He has trouble maintaining control over his blood sugar and is also obese. Both the patient and her husband often miss scheduled follow-up appointments. The patient’s medications are hydrochlorothiazide, atorvastatin, and an aspirin. Her father had hypertension and coronary artery disease, and her mother was recently diagnosed with type 2 diabetes mellitus. The patient works as an administrative assistant. She smokes half a pack of cigarettes a day and drinks a glass of wine occasionally. On examinationshe is pleasant and conversant and appears comfortable. She states that she thinks she may have “a little sugar” like her husband. Her vital signs are within normal limits, but her body mass index (BMI) is 37. Her lungs are clear to auscultation, and heart sounds are normal. Her abdomen is obese. Her neurologic exam is normal except for a decreased monofilament sensation in her feet. Differential Diagnosis Diabetes mellitus, type 1 Diabetes mellitus, type 2 Diabetes insipidus (DI) Hypercalcemia Gestational diabetes   Speaking Intelligently Polyuria is most often caused when the kidneys are subjected to an increased osmotic load, such as that from glucose or calcium. Alternatively, it may be due to endocrine disorders of fluid regulation such as vasopressin (antidiuretic hormone, ADH) deficiency. Conditions that cause bladder irritability or obstruction such as cystitis or prostatic enlargement can cause increased urinary frequency, but usually not polyuria. When most clinicians areassessing an obese patient with polyuria and polydipsia, type 2 $7 $7 $5 $14 $14 $6 $27, $12 $6 $18