Tasty Morsels of Critical Care Tasty Morsels of Critical Care 087 | Diabetes Insipidus
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Sep 1, 2025 Dive into the fascinating world of diabetes insipidus, where tasteless urine takes center stage. Learn about its two types: cranial DI, marked by a deficiency of antidiuretic hormone, and nephrogenic DI, involving resistance to this important hormone. Discover the critical role of ADH in regulating urine output and the challenges it presents in ICU settings. This discussion clarifies complexities within endocrinology, making the topic accessible for anyone navigating critical care.
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Two Distinct Forms In ICU
- Diabetes insipidus has two ICU-relevant forms: cranial (ADH deficiency) and nephrogenic (ADH resistance).
- These mirror diabetes mellitus pathophysiology but use different names in endocrinology.
How ADH Controls Water Balance
- ADH reduces urine volume by increasing aquaporin channels via V2 receptors in the kidney.
- ADH release is driven mainly by rising serum osmolality to conserve free water.
Diagnose And Treat Cranial DI Quickly
- In suspected cranial DI after severe brain injury, check urine osmolality and urine sodium to confirm dilute urine despite hypernatremia.
- Treat acutely with ADH replacement (DDAVP or vasopressin) to control polyuria before replacing free water.