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February 23, 2004

Diabetes Insipidus, Diagnosis and Symptoms

Question from Toronto, Ontario, Canada:

My daughter turned three at the end of December 2003. For the past six months or so, she has had an almost insatiable thirst, prevalent during the day, but primarily throughout the night. She drinks approximate two liters, by cup, from about 8 p.m. to about 8 a.m. It is difficult to measure her fluid intake during the day as she attends nursery school in the mornings. We try to distract her from her demands for drinks, but she is persistent and screams that she is "really thirsty". This thirst is usually not quenched after one cup; she usually needs two or three at one time, then gulps them quickly in succession. We have also observed excessive urination. She urinates pretty frequently throughout the day (far more than our four and a half year old daughter), but constantly and in copious amounts during the evening, night and early morning. She wears pull-ups at night, and we change her at least six times a night. In addition, and despite these changes, she wets through her pull-up and we change her bed at least once a night, sometimes twice or more. During her recent three year checkup with her regular pediatrician, she was found to be in the fifth percentile for height and 50th for weight, down significantly from one year ago when she was 50th for height and 75th for weight. She has grown only one and one half inches and added one and one half pounds in the past year, from ages two to three. A quick in-office dipstick test without withholding fluids showed that her urine was almost water. An in office test after withholding fluids for a whole night showed a concentration value of between 1015 and 1020. Her pediatrician is satisfied that this is normal and that she is concentrating her urine okay. In addition to the issues of excessive drinking and urination, she is also lethargic, usually looks tired and tires easily. She is also extremely irritable. Her other caregivers at home and school have also made these observations and say that she appears to be listless and "out of it", and that she drinks and urinates more and more frequently than the other children. Our regular pediatrician has expressed some concern about her growth, and would like to see her again once three months have passed so that he can check her height, etc. and extrapolate over a year to see if her growth is an issue. However, he is somewhat dismissive of the other issues and does not care to pursue further investigation of her excessive thirst and urination. He is satisfied that she does not have diabetes insipidus. We are not convinced and are very concerned about waiting another two months until she is measured again to see if her doctor will do anything. What should we do?

Answer:

I would suggest discussing your concerns at length with your pediatrician. You may also wish to ask if seeking a consultation with a pediatric endocrinologist would be helpful to you. The history you provide is markedly abnormal and requires continued work at your pediatrician’s office to find the cause.

I would have continued concerns not only about diabetes insipidus, but diabetes mellitus. There are other causes of abnormal water drinking that your pediatrician can help to investigate.

MSB