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April 4, 2007

Diagnosis and Symptoms

Question from Salt Lake City, Utah, USA:

My daughter has had ongoing problems since she turned one. We discovered she has food allergies (egg white, peanut, possible milk intolerance) and she apparently had minor failure to thrive as she dropped down a growth level or more. She hadn't lost weight, but hadn't been gaining either. Since we changed her diet in response to the food allergies, she is much happier and has gained 3 pounds. We noticed an increase in hunger and thirst and considered it a positive sign that the diet change was for the better She has had stool tests which were negative for bacteria, negative for celiac disease, and her initial diabetes blood test had a slightly higher than normal reading, but the second test was negative. She recently began wetting through her diapers frequently. In a recent doctor's visit, they had her drink water, then tested her urine and mentioned it was very dilute. The urine bag wasn't cooperative for a second test and we were referred to an endocrinologist. Could the water just before the test have made her urine more dilute? Could she have diabetes insipidus?

Answer:

It could be diabetes insipidus, although this is quite rare. Seeing if she can concentrate usually involves collecting a first morning urine specimen and testing for something called specific gravity. Holding back fluids for several hours is also sometimes necessary. You should be doing such “detective work” with a pediatric endocrinologist as this is somewhat complicated. Other cause of changes in urination and thirst patterns would involve some urinalyses and/or blood work to help sort themselves out. The small amount of fluid just before urine testing is unlikely to make much change since it would not likely be “processed” by the body so quickly.

SB