Approach to the Pt with Polyuria - Flowchart
Approach to the Pt with Polyuria - Flowchart
«Flowchart»

EVALUATION OF POLYURIA

Polyuria (>3 L/24 h)

EVALUATION OF POLYURIA

Polyuria (>3 L/24 h)

EVALUATION OF POLYURIA

EVALUATION OF POLYURIA

Polyuria (>3 L/24 h)

Polyuria

End

End

End

ADH, antidiuretic hormone; ATN, acute tubular necrosis.

ADH, antidiuretic hormone; ATN, acute tubular necrosis.

ADH, antidiuretic hormone; ATN, acute tubular necrosis.

Urine osmolality

Urine osmolality

Urine osmolality

<250 mosmol

<250 mosmol

<250 mosmol

>300 mosmol

>300 mosmol

>300 mosmol

Solute diuresis
Glucose, mannitol, radiocontrast, urea (from high protein feeding), medullary cystic diseases, resolving ATN, or obstruction, diuretics

Solute diuresis
Glucose, mannitol, radiocontrast, urea (from high protein feeding), medullary cystic diseases, resolving ATN, or obstruction, diuretics

Solute diuresis
Glucose, mannitol, radiocontrast, urea (from high protein feeding), medullary cystic diseases, resolving ATN, or obstruction, diuretics

Solute diuresis

Primary polydipsia
Psychogenic
Hypothalamic disease
Drugs (thioridazine, chlorpromazine, anticholinergic agents)

Primary polydipsia
Psychogenic
Hypothalamic disease
Drugs (thioridazine, chlorpromazine, anticholinergic agents)

Primary polydipsia
Psychogenic
Hypothalamic disease
Drugs (thioridazine, chlorpromazine, anticholinergic agents)

Primary polydipsia


History, low serum sodium

History, low serum sodium

History, low serum sodium

Water deprivation test or ADH level

Water deprivation test or ADH level

Water deprivation test or ADH level Water deprivation test or ADH level

Diabetes insipidus (DI)

Diabetes insipidus (DI)

Diabetes insipidus (DI) Diabetes insipidus

Nephrogenic DI (vasopressin-insensitive)
Acquired tubular diseases: pyelonephritis, analgesic nephropathy, multiple myeloma, amyloidosis, obstruction, sarcoidosis, hypercalcemia, hypokalemia, Sjögren's syndrome, sickle cell anemia
Drugs or toxins: lithium, demeclocycline, methoxyflurane, ethanol, diphenylhydantoin, propoxyphene, amphotericin
Congenital: hereditary, polycystic or medullary cystic disease

Nephrogenic DI (vasopressin-insensitive)
Acquired tubular diseases: pyelonephritis, analgesic nephropathy, multiple myeloma, amyloidosis, obstruction, sarcoidosis, hypercalcemia, hypokalemia, Sjögren's syndrome, sickle cell anemia
Drugs or toxins: lithium, demeclocycline, methoxyflurane, ethanol, diphenylhydantoin, propoxyphene, amphotericin
Congenital: hereditary, polycystic or medullary cystic disease

Nephrogenic DI (vasopressin-insensitive)
Acquired tubular diseases:
Drugs or toxins:
Congenital: Nephrogenic DI

Central DI (vasopressin-sensitive)
Posthypophysectomy, trauma, supra- or intrasellar tumor/cyst histiocystosis or granuloma, encroachment by aneurysm, Sheehan's syndrome, infection, Guillain-Barré, fat embolus, empty sella

Central DI (vasopressin-sensitive)
Posthypophysectomy, trauma, supra- or intrasellar tumor/cyst histiocystosis or granuloma, encroachment by aneurysm, Sheehan's syndrome, infection, Guillain-Barré, fat embolus, empty sella

Central DI (vasopressin-sensitive)
Central DI