Which nursing intervention should a nurse implement for a patient with diabetes insipidus?

Diagnosis

Tests used to diagnose diabetes insipidus include:

• Water deprivation test. While being monitored by a doctor and health care team, you'll be asked to stop drinking fluids for several hours. To prevent dehydration while fluids are restricted, ADH allows your kidneys to decrease the amount of fluid lost in the urine.

  While fluids are being withheld, your doctor will measure changes in your body weight, urine output, and the concentration of your urine and blood. Your doctor may also measure blood levels of ADH or give you synthetic ADH during this test. This will determine if your body is producing enough ADH and if your kidneys can respond as expected to ADH.

• Magnetic resonance imaging (MRI). An MRI can look for abnormalities in or near the pituitary gland. This test is noninvasive. It uses a powerful magnetic field and radio waves to construct detailed pictures of brain tissues.
• Genetic screening. If others in your family have had problems with excess urination, your doctor may suggest genetic screening.

Treatment

Treatment options depend on the type of diabetes insipidus you have.

• Central diabetes insipidus. If you have mild diabetes insipidus, you may need only to increase your water intake. If the condition is caused by an abnormality in the pituitary gland or hypothalamus (such as a tumor), your doctor will first treat the abnormality.

  Typically, this form is treated with a synthetic hormone called desmopressin (DDAVP, Nocdurna). This medication replaces the missing anti-diuretic hormone (ADH) and decreases urination. You can take desmopressin in a tablet, as a nasal spray or by injection.

  Most people still make some ADH, though the amount can vary day to day. So, the amount of desmopressin you need also may vary. Taking more desmopressin than you need can cause water retention and potentially serious low-sodium levels in the blood.

  Other medications might also be prescribed, such as chlorpropamide. This can make ADH more available in the body.

• Nephrogenic diabetes insipidus. Since the kidneys don't properly respond to ADH in this form of diabetes insipidus, desmopressin won't help. Instead, your doctor may prescribe a low-salt diet to reduce the amount of urine your kidneys make. You'll also need to drink enough water to avoid dehydration.

  Treatment with the drug hydrochlorothiazide (Microzide) may improve your symptoms. Although hydrochlorothiazide is a type of drug that usually increases urine output (diuretic), it can reduce urine output for some people with nephrogenic diabetes insipidus.

  If your symptoms are due to medications you're taking, stopping these medicines may help. However, don't stop taking any medication without first talking to your doctor.

• Gestational diabetes insipidus. Treatment for most people with gestational diabetes insipidus is with the synthetic hormone desmopressin.
• Primary polydipsia. There is no specific treatment for this form of diabetes insipidus, other than decreasing fluid intake. If the condition is related to a mental illness, treating the mental illness may relieve the diabetes insipidus symptoms.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

If you have diabetes insipidus:

• Prevent dehydration. As long as you take your medication and have access to water when the medication's effects wear off, you'll prevent serious problems. Plan ahead by carrying water with you wherever you go and keep a supply of medication in your travel bag, at work or at school.
• Wear a medical alert bracelet or carry a medical alert card in your wallet. If you have a medical emergency, a health care professional will recognize immediately your need for special treatment.

Preparing for your appointment

You're likely to first see your primary care doctor. However, in some cases when you call to set up an appointment you may be referred to a specialist called an endocrinologist.

Here's some information to help you get ready for your appointment.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance. Your doctor may ask you to stop drinking water the night before but do so only if your doctor asks you to.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Be prepared to answer specific questions about how often you urinate and how much water you drink each day.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of your key medical information, including recent surgical procedures, the names of all medications you're taking and doses, and any other conditions for which you've recently been treated. Your doctor will also want to know about any recent injuries to your head.
• Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

For diabetes insipidus, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• What kinds of tests do I need?
• Is my condition likely temporary or will I always have it?
• What treatments are available, and which do you recommend for me?
• How will you monitor whether my treatment is working?
• Will I need to make any changes to my diet or lifestyle?
• Will I still need to drink a lot of water if I'm taking medications?
• I have other health conditions. How can I best manage these conditions together?
• Are there any dietary restrictions I need to follow?
• Are there brochures or other printed material I can take home or websites you recommend?

What to expect from your doctor

Your doctor is likely to ask you several questions, including:

• When did you begin experiencing symptoms?
• How much more are you urinating than usual?
• How much water do you drink each day?
• Do you get up at night to urinate and drink water?
• Are you pregnant?
• Are you being treated, or have you recently been treated for other medical conditions?
• Have you had any recent head injuries, or have you had neurosurgery?
• Has anyone in your family been diagnosed with diabetes insipidus?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime

While you're waiting for your appointment, drink until your thirst is relieved, as often as necessary. Avoid activities that might cause dehydration, such as physical exertion or spending time in the heat.

April 10, 2021

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4. Melmed S, et al. Posterior pituitary. In: Williams Textbook of Endocrinology. 14th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Jan. 15, 2021.
5. Ferri FF. Diabetes insipidus. In: Ferri's Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed Jan. 15, 2021.
6. Kochhar RS, et al. Diabetes insipidus. Medicine. 2017;45:488.
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8. Bichet DG. Clinical manifestations and causes of central diabetes insipidus. https://www.uptodate.com/contents/search. Accessed Jan. 15, 2021.
9. Walls RM, et al., eds. Electrolyte disorders. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Jan. 15, 2021.
10. Levy M, et al. Diabetes insipidus. British Medical Journal. 2019; doi: 10.1136/bmj.l321.
11. Nippoldt TB (expert opinion). Mayo Clinic. Jan. 15, 2021.

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