Today's patient is a woman, Xiao Pan, 25 years old, 2 years after graduating from college.
Since the year of graduation, the boyfriend has found her abnormality, always feels that she is particularly prone to thirst, and has to carry a kettle everywhere she goes, and it doesn't take long to drink, and then she has to find water to drink.
That kind of 2 yuan a bottle of mineral water, three or two sips to drink, serious times have to drink several bottles a day, boyfriend is a box of water to buy back.
Suddenly one day, Xiao Pan realized the problem herself, because her father was also so prone to thirst, drink a lot of water, and people lost weight, went to the hospital to check blood sugar, blood sugar was as high as 20, and the doctor diagnosed diabetes.
Is he also diabetic?
Doctors have said that if an immediate family member has diabetes, the patient's own probability of diabetes will be greater than others. Coupled with the fact that she is now so easy to thirst and drink water, it is also in line with the symptoms of diabetes "three more, one less" (eating more, drinking more, peeing more, weight loss), thinking of this, she her scalp is numb.
She had seen the severity of diabetes, her father had been in a coma because of poor blood sugar control, and almost died in the hospital emergency department, in case she was really diabetic, it would be over.
On this day, the two of them went to the community hospital nervously, and Xiao Pan plucked up the courage to test for fasting blood glucose, and the result turned out to be normal.
A little lucky, but not quite convinced.
The next day, I went to the community hospital to take my blood sugar, and the results were normal.
The doctor said that two times in a row is normal, not diabetic, may be more prone to thirst, drink more water is not a big problem.
Aftermath.
False alarm, Xiao Pan and her boyfriend were extremely happy, and they ate a big meal that night to reward themselves.
It didn't take long for new distress to come.
For several days in a row, I woke up in the morning to find that my underwear was soaked, Xiao Pan was embarrassed to death, he leaked urine in the middle of the night, he didn't have much consciousness, and it was really humiliating to lose his home.
It must be more troublesome to drink water before going to bed, Xiao Pan thought in his heart, but before going to bed, it is indeed thirsty, not drinking water is not OK, it is said that women are made of water, if there is a lack of water, the skin will be bad. But the problem of enuresis in the middle of the night really worried her, and she used to drink a lot of water, but never like this.
Could it be a kidney problem?
Thinking of this, she was nervous again, thinking about it, or told her boyfriend. After some deliberation, the two decided to ask the doctor for clarification. After the introduction of acquaintances, found a special chinese medicine doctor to see kidney disease, the clinic of chinese medicine doctors in the city village, there are many people in line, it is difficult to queue to Xiao Pan, the doctor suspected that it was kidney deficiency after reading, prescribed some drugs.
After eating for more than a week, there was no effect, or enuresis in the middle of the night, for which Xiao Pan had to buy adult diapers.
No, I have to go to the hospital. Little Pan's boyfriend said.
The hospital is very crowded, and queuing up for registration is a problem. After simply listening to Xiao Pan's description, the doctor prescribed a series of examinations, including urinary tract ultrasound, and first did the examination and then came back to see.
Cai Chao took a look at it, and he couldn't help it. It turned out that Xiao Pan's kidneys were heavily hydrostatic, and the bilateral ureters were also fully dilated.
This is definitely a big problem.
In general, the kidneys, ureteral hydrops, the most common reason is that there are stones blocked, for example, the ureter has stones, stones completely block the ureter, then the urine can not be smoothly discharged, urine will accumulate above the stones, so it will lead to ureteral and kidney expansion above the stones.
Now Xiao Pan's bilateral kidneys and ureters are significantly dilated.
Curiously, the color ultrasound did not find stones or tumors or anatomical abnormalities that could cause water accumulation.
Xiao Pan was also frightened after seeing the results, in order to see more clearly, the doctor suggested doing a CT to see the urinary tract situation more clearly.
The results came out, similar to the color ultrasound, the kidneys, ureter dilation is very strong, normal people's ureter is as thick as an ordinary straw, and Xiao Pan's ureter is almost as big as the thumb.
Not only the kidneys and ureters are hydrostatic, the bladder is also very dilated, and there is a lot of urine in it, which seems to be left behind.
The situation is somewhat complicated, and it is necessary to be hospitalized and admitted to the nephrology department.
After a thorough examination, the doctor gave a diagnosis that this is chronic urinary retention, neurogenic bladder.
That is to say, the reason why Xiao Pan has such obvious kidney and ureteral dilation is entirely because the bladder cannot excrete the urine in time, and the excess urine will accumulate in the bladder, ureter, and even the kidneys, and over time, the kidneys and ureters will expand, which is called compensatory expansion.
The question is, why doesn't the bladder drain urine in time?
The bladder itself is wrong.
It is likely that the bladder is out of control due to a problem with the central nervous system or peripheral nervous system. Normal people have a certain amount of urine in the bladder will stimulate the nerves, causing urinary intentions, so that we have to go to the toilet to urinate. However, Xiao Pan's bladder nerves may be confused, can not form an effective urinary urination process, even if the number of urination is large, can not completely empty the bladder, enuresis will occur in the middle of the night.
The problem was found.
The doctor said to do a brain MRI to see if there was a tumor in the brain or if there was a problem with the spinal cord, causing the bladder nerve to be out of control.
Hearing that there may be a brain problem, Xiao Pan was even more afraid.
Fortunately, after the CRANI results came out, they were all normal, there was no tumor, the spinal cord was also examined, and there was no problem.
If it is not the cause of the brain, it may be peripheral neuropathy, such as diabetes, that can also damage the nerves around the bladder, causing a neurogenic bladder. But Xiao Pan said that he had checked his blood sugar before, and it was normal and there was no diabetes.
However, Xiao Pan's series of symptoms made the doctor have to suspect. The bed tube doctor noticed that since the beginning of admission, the kettle on the head of Xiao Pan's bed has not been available, and the boyfriend has also fetched water for her to drink all day long, and then went to the toilet after drinking.
Isn't this a typical symptom of thirst, polydipsia, polyuria, which is a typical symptom of diabetes.
But Xiao Pan took out two fasting blood glucose reports, and it was really normal.
In order to further rule out diabetes, the doctor also checked the glycosylated hemoglobin, insulin level, and OGTT test (oral glucose tolerance test).
The results are all normal.
Xiao Pan is really not diabetic.
However, serum creatinine is on the high side, which indicates that bladder function may already be impaired. The results of the urine routine also came out, and the specific gravity of Xiao Pan's urine was reduced, that is, the urine was diluted because there was more water.
Anyway, first insert a urinary catheter, drain the excess urine in the bladder and then say, relying on Xiao Pan himself seems to be unable to completely discharge, because the bladder sphincter is not very well moved, the urine is not clean, and it is easy to urinate at night.
After the urinary catheter was inserted, I began to be able to accurately calculate the amount of urine.
Doctors say that in the case of a neurogenic bladder, the amount of urine will be more in the first few days, but the amount of urine will gradually decrease in the next few days.
However, since the insertion of the urinary catheter, Xiao Pan's urine bag will be full in a short time, Xiao Pan is constantly drinking water, and the urine in the urine bag below continues to gush out, and at the end of the day, there are almost 8,000 ml of urine, which is like this for several days in a row.
That's not right.
Patients with so much urine output have definitely ruled out diabetes, and there should be other problems.
And a relatively rare disease is put on the agenda by everyone.
diabetes insipidus.
diabetes insipidus? After Xiao Pan heard about it, although he was surprised, he felt that this name was definitely not wronged himself, he really had a urinary collapse, and he felt that the amount of urine was like a collapsed reservoir, and it had not stopped.
The nephrologist also invited an endocrinologist to come and consult.
After the endocrinologist analyzed the situation of Xiao Pan, he said that diabetes insipidus is a rare endocrine disease, because a certain hormone in the patient's body (vasopressin, also called antidiuretic hormone, which can promote the reabsorption of water by the renal far curved tubules, that is, antidiuretic effect) content is less, or the kidneys are not so sensitive to this hormone, resulting in the patient's urine can not be well reabsorbed, but directly excreted, so the urine volume is particularly large, generally there will be more than 4000 ml a day, some exaggerated may have tens of thousands of ml of urine a day, At the same time, patients will have symptoms of polydipsia and excessive drinking, a bit like diabetes, but not diabetes, the patient's blood sugar is no problem, and there will be no obvious emaciation.
What causes diabetes insipidus?
Most of them are central diabetes insipidus, that is, caused by the brain, and many lesions of the hypothalamus and pituitary gland may lead to a decrease in the secretion of this hormone. There is also a renal diabetes insipidus, which means that the kidneys are not sensitive to this hormone.
However, the patient had a head MRI and did not see any abnormalities.
Many brain diseases MRI is also difficult to find, if it is a head tumor, bleeding it is easy to find, but if it is encephalitis, vascular lesions or some autoimmune diseases, MRI can not be fully displayed.
So how can a definitive diagnosis be made?
Do a water ban test.
After normal people abstain from water, the amount of urine will be reduced, the proportion of urine and the osmolality of urine will increase, this is because of a kind of regulation of itself, the amount of water is reduced, the body will inevitably secrete more antidiuretic hormone, to reduce the amount of urine, maintain normal body function, to put it bluntly, is to drink less water, less urine output.
If it is a diabetes insipidus patient, because of its own lack of this hormone or hormone insensitivity, the urine output will not be significantly reduced after water abstinence, and it will continue to be low infiltration, and the proportion of urine is still low. At this time, then give vasopressin test (give vasopressin subcutaneous injection), continue to observe, if it is central diabetes insipidus, after we use hormones, the urine output will gradually decrease, and the proportion of urine will also rise. If it is renal diabetes insipidus (hormone insensitivity), the urine output will not change significantly after the hormone is used.
After the water pressure test, Xiao Pan's diagnosis was clear.
She does have a central diabetes insipidus, and her brain secretes less antidiuretic hormone, so it does not reabsorb the urine output well, resulting in an increase in urine output. People are also particularly prone to thirst, in the words of her boyfriend, that is, they are eager to take this faucet with them, and they must drink water everywhere they go. The amount of urine is too large, and this can lead to dilated ureters and kidneys in the long run.
The treatment method is also relatively simple, that is, artificial supplementation of this hormone, oral vasopressin (antidiuretic hormone), which is called hormone replacement therapy.
Although there is no cure, but at least there is a drug that can control the disease, Xiao Pan is already very happy. Since this time, due to the particularly large amount of urine and the special amount of water she drank, she was very distressed and seriously affected her life. Although the doctor also said that as long as the amount of water can be guaranteed, it will generally not cause life-threatening, but what if there is no water?
Since the amount of urine is high, she does not dare to take the bus without a toilet for a long time, and she is always looking for a toilet when shopping, and she is very tired.
This can be good, after oral vasopressin, the effect is also immediate, the amount of urine is less, the amount of urine monitored a day is also 3000-4000ml, more than normal people, but compared to the previous can not move close to 10000ml, it is very good.
As for why Xiao Pan has central diabetes insipidus, it may be necessary to continue to improve the examination, and perhaps the cause can not be found, and can only continue to take this hormone orally to treat it.
Xiao Pan is lucky to get, the director of the rounds said that there was a medical lawsuit before, but also a diabetes insipidus patient, but also a young woman, has been drinking more, urine more, the community doctor did not check blood sugar, directly considered diabetes, to eat hypoglycemic drugs, excellent hypoglycemic, this drug can stimulate insulin secretion, reduce blood sugar, but after the medication patients still continue to drink water, pull urine, think that the effect is not good, and added the amount of medicine, and eventually led to the patient's hypoglycemia, electrolyte disorders and death.
Diabetes insipidus, not diabetes, is diagnosed before death.
Hopefully, this case will help people.
I wish you all the best.
(End)
Non-hospital cases, issued a document for vigilance, the patient's name in the text is pseudonymous.