Why is there hypoproteinemia in diabetes insipidus

Pathogenesis

A distinction is made between the following Forms of hypernatremia:

  • Hypovolemic hypernatremia (= hypertonic dehydration): too high sodium concentration with simultaneously reduced intravascular volume ("in the vessels"); this is created by:
    • increased fluid excretion (urine, sweat)
    • due to illness, e.g. B .:
      • Deficiency of the antidiuretic hormone (ADH) due to Failure of ADH production (partial (partial) or total; permanent or transient (temporary)), which leads to an extremely high urine excretion (polyuria; 5-25 l / day) due to the kidneys' restricted ability to concentrate
      • due to a lack of or insufficient response of the kidneys to ADH (ADH concentration is normal or even increased)
      • see below diseases
    • medicinal
  • Hypervolemic hypernatremia (= hypertonic hyperhydration): too high sodium concentration with simultaneously increased intravascular volume; this is caused by excessive salt intake; The causes are:
    • alimentary (diet-related): seawater intoxication (drinking salt water)
    • iatrogenic (e.g. infusion of hypertonic saline or sodium bicarbonate solution or sodium-containing penicillin salts)

The physiological serum osmolarity depends almost exclusively on the sodium concentration. This is accompanied by hypernatremia and hyperosmolality (hyperosmolarity).
Osmolality is the sum of the molar concentration of all osmotically acting particles per kilogram of solvent. In the case of hyperosmolality (hyperosmolal) there is a greater number of dissolved particles per kilogram of liquid than in the comparison liquid.

While the intracellular ("inside the cells") sodium concentration is controlled by the Na + / K + -ATPase, the regulation of the sodium concentration in the extracellular space (space outside the cells) takes place via the renin-angiotensin-aldosterone system (RAAS) and the atrial natriuretic system Peptide (ANP). For details, see "Table salt / Regulation of sodium homeostasis".

Etiology (causes)

Behavioral causes

  • nutrition
    • Decreased hydration
    • High intake of sodium and table salt
    • Micronutrient deficiency (vital substances) - potassium

Disease-related causes

Endocrine, nutritional and metabolic diseases (E00-E90)

  • Conn syndrome (primary hyperaldosteronism); Aldosterone is a mineralocorticoid that regulates the fluid and electrolyte (blood salt) balance with other hormones such as renin and angiotensin.
  • Diabetes insipidus centralis (synonyms: central (neurogenic) diabetes insipidus; diabetes insipidus neurohormonalis; hypoyphyseal diabetes insipidus - disorder in the hydrogen exchange, caused by a deficiency in the antidiuretic hormone (ADH) due to failure of ADH production (partial (partial) or total ; permanent or transient (temporary)), which leads to an extremely high urine excretion (polyuria; 5-25 l / day) due to a restricted ability of the kidneys to concentrate.
  • Cushing's disease - group of diseases that lead to hypercortisolism (hypercortisolism)

Infectious and parasitic diseases (A00-B99)

  • Diarrhea

Liver, gallbladder and biliary tract - pancreas (pancreas) (K70-K77; K80-K87)

  • Pancreatitis (inflammation of the pancreas)

Mouth, esophagus (gullet), stomach, and intestines (K00-K67; K90-K93)

  • Ileus (bowel obstruction)
  • Non-infectious gastroenteritis (inflammation of the stomach and intestines) and colitis (inflammation of the intestines)
  • Peritonitis (inflammation of the peritoneum)

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)

  • Fever (→ fluid loss)
  • Hyperglycaemia (high blood sugar → osmotic diuresis)
  • Hyperhidrosis (abnormally increased sweating; night sweats; sweating; tendency to sweat; increased sweat secretion; excessive sweating)
  • Hyperventilation (increased breathing beyond what is needed)
  • Polyuria (increased urination)

Urogenital system (kidneys, urinary tract - genital organs) (N00-N99)

  • Diabetes insipidus renalis (synonym: nephrogenic diabetes insipidus; ICD-10 N25.1) - disorder in the hydrogen exchange caused by a lack of or inadequate response of the kidneys to ADH (ADH concentration is normal or even increased) leading to an extremely high urine excretion (Polyuria; 5-25 l / day) leads to a restricted ability of the kidneys to concentrate.
  • Nephropathies (kidney disease) with impaired ability to concentrate
  • Nephrotic syndrome - collective term for symptoms that occur in various diseases of the glomerulum (kidney corpuscles); the symptoms are proteinuria (increased excretion of protein in the urine) with a loss of protein; Hypoproteinemia, peripheral edema (water retention) due to hypoalbuminemia (low levels of albumin in the blood), hyperlipoproteinemia (lipid metabolism disorder)
  • Renal insufficiency (process that leads to a slowly progressive decrease in kidney function)
  • Polyuric kidney failure (polyuria in ANV / acute kidney failure)

Injuries, poisoning and other consequences of external causes (S00-T98)

  • Sea water intoxication (drinking salt water)
  • Burns

Further differential diagnoses

  • Iatrogenic (e.g. infusion of hypertonic saline or sodium bicarbonate solution or sodium-containing penicillin salts)
  • Increased perspiratio insensibilis (not noticeable loss of body water via the skin (evaporation), mucous membranes and breathing (moisture content of the exhaled air)) - usually between 300-1,000 ml per day (the information on the extent of perspiratio insensibilis varies greatly in the literature)
  • Stoma (ostomy carrier), fistulas

Medication (with sodium-retaining effect or medicinal salt overload)

  • Hormones: Glucocorticoids (Hydrocortisone; Prednisolone)
  • Saline infusion solutions
  • Selective COX-2 inhibitors (coxibs) - celecoxib, etoricoxib
     
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