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1. Clinical approach-polyuria

2. polyuria
>3L/d
Differentiate fm inc frequency
Collect 24hr urine

3. causes
• Physiological • Pathological
Excessive intake of fluid Endocrine
Cold climate Renal
Anxiety Systemic
Pro rich diet
Psychiatric
Drugs
Iatrogenic

4. 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

5. 4. Psychiatric-schizophrenia
5. Drugs- diuretics,Li,anticholinergics
6. Iatrogenic-excessive IVF, mannitol
infusion,radiocontrast media

6. >3L/d
<250 mosmol >300mosmol
solutes/d solutes/d
 Water diuresis  Solute/osmotic diuresis
 Polydipsia  Glucose[DM]
 DI  Mannitol
WATER DEPRIVATION TEST ,  Urea[pro]
ADH SENSITIVITY
 Na+[diuretics]
 Ca2+[hyperparathyroid]

7. History
1.Gen data
2.PC- polyuria
3.HOPC-
# ass with fatigue,wt loss » DM
# ass with depression » prim.Hyperparathy.
# ass with bone pain » multiple myeloma
# oliguria first » ATN

8. 4.Past History-
#h/o transurethral resection of prostate » post
obstructive diuresis
#h/o neurosurgery » central DI
5.Personal History-
Diet-protein
Appetite-DM
Addiction-caffeine

9. 6.Family History- DM, PKD, Sickle cell
anemia
7.Treatment History- diuretics,Li,
anticholinergics
8.Allergic History
9.SES
10.Menstrual history

10. Gen examination
 Poorly built & nourished- DM
 Coma- natriuresis
 Not oriented- schizophrenia
 Pallor- sickle cell anemia, CRF
 Edema- RF

11.  Pulse
high vol- DM, Sickle cell anemia,
pyelonephritis
low vol- electrolyte imbalance
 BP
high-DM, PKD, Conn’s
low- DI

12.  Febrile- pyelonephritis
 Tachypnoea- DM,Bartter’s syndrome

13. GIT examination
 inspection- dry oral cavity- sjogren’s
syndrome, anticholinergics
 palpation- pain- pyelonephritis;
mass- PKD

14.  Percussion- dull note- PKD
 Auscultation- bruits- RF