Treatment-polyuria

• 1° polydipsia:
  • treat psychiatric illness,
  • check meds,
  • restrict access to free H2O
• Osmotic diuresis:
  • address underlying cause,
  • replace free H2O deficit
  • (see “hypernatremia” for formula to calculate) and ongoing losses

Treatment of Diabetes insipidus

• treatment of Central DI: desmopressin (dDAVP, 1st line), low Na/protein diet + Hydrochlorothiazide (HCTZ), chlorpropamide
• Nephrogenic DI:
  • treat underlying cause if possible;
  • Na restriction + HCTZ (mild volume depletion → ↓ delivery of filtrate for free H2O absorption),
  • consider amiloride for Li- induced DI (Kid Int 2009;76:44), indomethacin (NEJM 1991;324:850) or trial desmopression
• Pregnancy-induced DI:
  • due to vasopressinase from placenta
  • ∴ Rx w/ dDAVP