How do NSAIDs treat nephrogenic diabetes insipidus?

Blockade of prostaglandin E(2) synthesis by nonsteroidal anti-inflammatory drugs (NSAIDs) enhances urinary concentration, and these agents have antidiuretic effects in patients with nephrogenic diabetes insipidus (NDI) of different etiologies.

Why Indomethacin is used in nephrogenic diabetes insipidus?

To the Editor: In patients with lithium-induced nephrogenic diabetes insipidus, indomethacin has been reported to decrease urinary output and raise urinary osmolality. Indomethacin is an inhibitor of prostaglandin synthesis in the kidney.

How does amiloride help nephrogenic diabetes insipidus?

Amiloride blocks lithium entry through the sodium channel thereby attenuating the resultant nephrogenic diabetes insipidus.

What is the drug of choice for diabetes insipidus?

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.

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Why do you treat nephrogenic diabetes insipidus with hydrochlorothiazide?

Thiazides have been used in patients with nephrogenic diabetes insipidus (NDI) to decrease urine volume, but the mechanism by which it produces the paradoxic antidiuretic effect remains unclear.

How do thiazide diuretics work in diabetes insipidus?

Thiazide diuretics inhibit the NaCl co-transporter (NCC/TSC) in the renal distal convoluted tubule (DCT) (8). The DCT is water impermeable and considered to be part of the diluting segment (8). Therefore, the water-preserving effect of thiazides is unlikely related to a direct effect on the DCT.

What is desmopressin tablets used for?

Desmopressin is a man-made form of vasopressin and is used to replace a low level of vasopressin. This medication helps to control increased thirst and too much urination due to these conditions, and helps prevent dehydration. Desmopressin is also used to control nighttime bedwetting in children.

How is lithium-induced nephrogenic diabetes insipidus treated?

Clinicians have been aware of lithium toxicity for many years and traditionally have administered thiazide diuretics for lithium-induced polyuria and nephrogenic diabetes insipidus. Recently, amiloride, a potassium-sparing diuretic, has been reported as a successful treatment for nephrogenic diabetes insipidus.

What is ICD 10 code for nephrogenic diabetes insipidus?

Nephrogenic diabetes insipidus

N25. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

Why does lithium cause nephrogenic diabetes insipidus?

Chronic lithium therapy can lead to accumulation in distal tubular cells causing impaired urinary concentrating ability. This can lead to partial or full nephrogenic diabetes insipidus. It is estimated to be present in up to 40% of patients on chronic lithium therapy [1].

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What is the difference between central and nephrogenic diabetes insipidus?

Central DI (CDI) is due to a lack of the hormone vasopressin (antidiuretic hormone). This can be due to injury to the hypothalamus or pituitary gland or genetics. Nephrogenic DI (NDI) occurs when the kidneys do not respond properly to vasopressin.

Which IV fluids would you recommend for a patient with diabetes insipidus?

Most patients with diabetes insipidus (DI) can drink enough fluid to replace their urine losses. When oral intake is inadequate and hypernatremia is present, replace losses with dextrose and water or an intravenous (IV) fluid that is hypo-osmolar with respect to the patient’s serum.

Why does hypokalemia cause nephrogenic diabetes insipidus?

One of the renal impairments caused by hypokalemia is a reduction in urinary concentrating ability and a lack of response to the antidiuretic hormone arginine vasopressin (AVP), resulting in nephrogenic diabetes insipidus (NDI; characterized by excessive thirst and excretion of large amounts of very dilute urine).

What are the complications of nephrogenic diabetes insipidus?

NDI causes chronic excessive thirst (polydipsia), excessive urine production (polyuria), and potentially severe dehydration. If left untreated, repeated episodes of severe dehydration may develop, eventually resulting in serious complications. Most cases of hereditary NDI are inherited as X-linked recessive disorders.

Is nephrogenic diabetes insipidus fatal?

NDI can be fatal if you don’t get treatment for it. The earlier you receive the diagnosis, the better your outlook will be. NDI is unrelated to diabetes mellitus, which is more commonly known as diabetes.

How can thiazide diuretics effectively reduce hypertension?

By decreasing sodium reabsorption, thiazide use acutely results in an increase in fluid loss to urine, which leads to decreased extracellular fluid (ECF) and plasma volume. This volume loss results in diminished venous return, increased renin release, reduced cardiac output and decreased blood pressure [7].

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