clinical approach to a patient complaining of polyuria
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Clinical approach-polyuria
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polyuria
>3L/dDifferentiate fm inc frequencyCollect 24hr urine
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causes
• PhysiologicalExcessive intake of fluidCold climateAnxietyPro rich diet
• PathologicalEndocrineRenalSystemicPsychiatricDrugsIatrogenic
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1. Endocrine- DM, Central DI, Hyperparathyroidism, cushing’s & conn’s syndrome
2. Renal-CRF(early),ATN(diuretic phase), pyelonephritis,nephrogenic DI
3. Systemic- amyloidosis,sickle cell anemia
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5. Drugs- diuretics,Li,anticholinergics
6. Iatrogenic-excessive IVF, mannitol infusion,radiocontrast media
4. Psychiatric-schizophrenia
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>3L/d<250 mosmol solutes/d
Water diuresis Polydipsia DIWATER DEPRIVATION TEST ,
ADH SENSITIVITY
>300mosmol solutes/d
Solute/osmotic diuresis Glucose[DM] Mannitol Urea[pro] Na+[diuretics] Ca2+[hyperparathyroid]
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History
1.Gen data2.PC- polyuria3.HOPC-# ass with fatigue,wt loss » DM# ass with depression »
prim.Hyperparathy.# ass with bone pain » multiple
myeloma# oliguria first » ATN
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4.Past History-#h/o transurethral resection of
prostate » post obstructive diuresis
#h/o neurosurgery » central DI
5.Personal History-Diet-proteinAppetite-DMAddiction-caffeine
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6.Family History- DM, PKD, Sickle cell anemia
7.Treatment History- diuretics,Li, anticholinergics
8.Allergic History9.SES10.Menstrual history
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Gen examination
Poorly built & nourished- DM Coma- natriuresis Not oriented- schizophrenia Pallor- sickle cell anemia, CRF Edema- RF
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Pulse high vol- DM, Sickle cell
anemia, pyelonephritis low vol- electrolyte imbalance BP high-DM, PKD, Conn’s low- DI
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Febrile- pyelonephritis
Tachypnoea- DM,Bartter’s syndrome
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GIT examination
inspection- dry oral cavity- sjogren’s syndrome, anticholinergics
palpation- pain- pyelonephritis;
mass- PKD
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Percussion- dull note- PKD
Auscultation- bruits- RF
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THANK U…