This document provides guidance on evaluating and differentiating the causes of polyuria, which is excessive urine output of more than 3 L/day. It lists physiological causes such as excessive fluid intake or environmental factors and pathological causes including endocrine disorders like diabetes mellitus, renal issues like chronic kidney disease, and drugs that can cause polyuria. The evaluation involves collecting a 24-hour urine output, performing a water deprivation test, and considering the patient's history, examination findings, and laboratory tests to identify the underlying cause.

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