Insipidus diabetes

ʻO ka Diabetes insipidus (DI) kahi kūlana maʻamau ʻole i hiki ʻole i nā puʻupaʻa ke pale i ka excretion o ka wai.

ʻAʻole like ka DI me ka diabetes mellitus ʻano 1 a me 2. Eia nō naʻe, ʻaʻole i mālama ʻia, ʻo DI a me diabetes mellitus ke kumu o ka make wai mau a me ka urination pinepine. Loaʻa i nā kānaka me ka maʻi diabetes i ke kō kō (glucose) kiʻekiʻe no ka mea ʻaʻole hiki i ke kino ke hoʻohana i ke kō kō no ka ikehu. ʻO nā mea me DI he pae kō kō kō, akā ʻaʻole hiki i ko lākou puʻupaʻa ke kaulike i ka wai i ke kino.

I ka lā, kānana kou mau puʻupaʻa i kou koko i nā manawa he nui. ʻO ka maʻamau, hoʻopili hou ʻia ka hapa nui o ka wai, a heʻuʻuku wale ka nui o ka mimi paʻa i hoʻopau ʻia. Kū ʻia ʻo DI ke hiki ʻole i nā puʻupaʻa ke hoʻoliʻiliʻi i ka mimi maʻa mau, a he nui ka nui o ka mimiki dilute e hoʻopau ʻia.

ʻO ka nui o ka wai i hoʻopuka ʻia i loko o ka mimi e kaohi ʻia e ka hormone antidiuretic (ADH). Kāhea ʻia ʻo ADH vasopressin. Hana ʻia ʻo ADH ma kahi ʻāpana o ka lolo i kapa ʻia ʻo hypothalamus. Mālama ʻia ia a hoʻokuʻu ʻia mai ka pituitary gland. ʻO kēia gland liʻiliʻi ma lalo pono o ke kumu o ka lolo.

Ua kapa ʻia ʻo DI ma muli o ka nele o ADH i kapa ʻia ʻo diabetes insipidus waena. Ke kumu ʻia ʻo DI e ka holo pono ʻole o nā puʻupaʻa e pane iā ADH, ua kapa ʻia kēia ʻano he nephrogenic diabetes insipidus. ʻO ke ʻano o ka nephrogenic e pili ana i ka puʻupaʻa.

Hiki i ka DI DI ke kumu ʻia e ka hōʻino ʻana i ka hypothalamus a i ʻole ka pituitary gland ma muli o:

• Nā pilikia genetic
• Poino poʻo poʻo
• Maʻi kīnā
• Pilikia me nā keʻa hana ADH ma muli o kahi maʻi autoimmune
  
• Loaʻa ka loaʻa ʻole o ke koko i ka pituitary gland
• ʻO keʻoki ma kahi o ka pituitary gland a hypothalamus paha
• Nā Tumors i loko a kokoke paha i ka pituitary gland

Hoʻopili ka nephrogenic DI i kahi kīnā i nā puʻupaʻa. ʻO ka hopena, ʻaʻole pane nā puʻupaʻa iā ADH. E like me DI nui, kakaʻikahi loa ka nephrogenic DI. Hoʻokumu ʻia paha ʻo Nefrogenic DI e:

• ʻO kekahi mau lāʻau, e like me ka lithium
• Nā pilikia genetic
• ʻO ke kiʻekiʻe o ka calcium i loko o ke kino (hypercalcemia)
• ʻO ka maʻi kīnā, e like me ka maʻi polycystic kidney

ʻO nā ʻōuli o DI ka:

• Make wai nui a ikaika ʻole paha kaohi ʻole, maʻamau me ka pono e inu i ka nui o ka wai a i ʻole ka ʻiʻini i ka wai hau.
• Volume mimi nui loa
• ʻO ka urination nui loa, pono pinepine i ka mimiki i kēlā me kēia hola a puni ka lā a me ka pō
• Holo loa, mimi pale

E nīnau ka mea mālama ola e pili ana i kāu mōʻaukala a me nā ʻōuli.

ʻO nā hoʻokolohua i kauoha ʻia e komo pū:

• ʻO ka sodium sodium a me osmolality
• Desmopressin (DDAVP) ʻaʻa
• MRI o ke poʻo
• Urinalysis
• ʻO ka mimiki a me ka osmolality
• Pihi mimi

ʻIke paha kāu mea hāʻawi iā ʻoe i ke kauka e loea i nā maʻi pituitary e kōkua i ke kuhi DI.

E mālama ʻia ke kumu o ke kumu paʻa ke hiki.

Hiki ke kāohi ʻia ʻo DI DI me vasopressin (desmopressin, DDAVP). Lawe ʻoe i ka vasopressin ma ke ʻano he injection, he nasal spray, a i ʻole nā ​​papa.

Inā kumu ʻia ka nephrogenic DI e ka lāʻau, ke hoʻōla ʻana i ka lāʻau i hiki ke kōkua i ka hoʻihoʻi ʻana i ka hana maʻamau maʻamau. Akā ma hope o nā makahiki he nui o ka hoʻohana ʻana i kekahi mau lāʻau, e like me ka lithium, hiki ke mau loa ka nephrogenic DI.

Mālama ʻia ka nephrogenic DI a me ka lithium-i hoʻokomo ʻia nephrogenic DI e ka inu ʻana i nā wai e kūlike me ka puka mimi. Pono e lawe i nā lāʻau e hoʻohaʻahaʻa i ka mimi.

Mālama ʻia ʻo Nefrogenic DI me nā lāʻau anti-inflammatory a me nā diuretics (nā wai wai).

Loaʻa ka hopena i ka maʻi maʻi. Inā mālama ʻia, ʻaʻole kumu ʻo DI i nā pilikia koʻikoʻi a i ʻole ka hopena i ka make mua.

Inā maʻamau ka ka make wai o kou kino a hiki iā ʻoe ke inu i ka wai lawa, ʻaʻohe hopena koʻikoʻi i ka wai o ke kino a i ʻole ke kaulike paʻakai.

ʻO ka inu ʻole ʻana i nā wai e hiki ai ke alakaʻi i ka make wai a me ke kaulike ʻole electrolyte, a he mea weliweli loa ia.

Inā mālama ʻia ʻo DI me vasopressin a ʻaʻole maʻamau ka kauka make wai o kou kino, ʻo ka inu ʻana i nā wai ʻoi aku ka nui ma mua o kou kino e hiki ai ke hōʻeha i ka uila electrolyte.

Kāhea i kāu mea hāʻawi inā hoʻomōhala ʻoe i nā ʻōuli o DI.

Inā he DI ʻoe, e hoʻopili aku i kāu mea hāʻawi inā pinepine ka urination a i ʻole ka make wai makepono loa.

• Nānā Endocrine
• Hōʻike Osmolality

ʻO Hannon MJ, ʻo Thompson CJ. ʻO Vasopressin, diabetes insipidus, a me ka maʻi o ka antidiuresis kūpono ʻole. I: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Makua a Pediatric. ʻEpekema 7 Piladelapia, PA: Elsevier Saunders; 2016: chap 18.

ʻO Verbalis JG. Nā maʻi o ke kaulike wai. I: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, eds. ʻO Brenner a me Rector's The Kidney. 10 o ka lā. Piladelapia, PA: Elsevier; 2016: chap 16.