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April 3, 2007

Diabetes Insipidus, Diagnosis and Symptoms

Question from Hampton, Virginia, USA:

My 19-month-old son is a heavy duty drinker. In one day, he will easily drink over 100 to 150 ounces of water a day. He weighs 23 pounds. We had a doctors appointment for this yesterday and the doctor told me that he is a "comfort drinker" and that we should just take away his cups and only give him three a day. But, my son will scream seriously for hours if I withhold water from him. He constantly has diarrhea. He will choose water over food, no matter what I put in front of him. If he gets busy and "forgets" to drink water, when he remembers, he will chug three or four in a row. Yesterday, we did a urine catch and he wore a bag in his diaper. It was completely full in 15 minutes. When I dumped the urine from the bag to the cup, it was completely clear. I didn't notice any yellow tint to it at all. His urine also tends to have a bitter smell. The doctor told me that everything in his blood tests looked normal, but the urine test hadn't come back yet. Would they have actually tested for this? Or, would she have just tested him for type 1 diabetes? Does this sound like diabetes insipidus?

Answer:

Common “routine” checks of blood and urine chemistries will check for glucose. Did they in YOUR child? I don’t know. Ask the pediatrician.

Not uncommonly, toddlers with diabetes with the increased thirst and urination that you described are sick. And, typically, the urine is NOT essentially colorless.

Could this be diabetes insipidus? YES! It could be other things, too. Your pediatrician needs to view matters with an open mind. If your child has not seen a pediatrician, I might suggest that you make an appointment and relay this information.

IF the child has diabetes insipidus, the next question that must be addressed is “WHY?” Diabetes Insipidus does not typically “just occur out of the blue.” There is usually a pituitary or kidney cause found, if looked for. And these issues can be serious.

I might suggest that you try to refrain the child from drinking or eating ANYTHING from about midnight to 8 a.m. and have the child go in for simultaneous urine and blood work at 8 a.m. Arrange with your doctor to coordinate what is needed. If s/he is uncertain, they should confer with a pediatric endocrinologist, but not only should blood glucose be checked, but also serum electrolytes, serum osmolality, urine osmolality and other chemistries.

DS

[Editor’s comment: For more information, see The Diabetes Insipidus Foundation, Inc. web site.

BH]