The reasons, you see, are the ways of lіkuvannya uncrowned diabetes. Also non-bloody diabetes - causes of pregnancy and disease Non-bloody diabetes causes symptoms of diabetes

Hypothalamic diabetes mellitus, hypochondriacal diabetes mellitus, neurohypophysial diabetic diabetes mellitus, diabetes insipidus.

value

non-bloody diabet- enfeebled, which is characterized by a lack of energy to reabsorb water and concentrate it, so that in its basis there is a defect in the secretion or even vasopressin and manifests itself in a swollen sprout and an eccentric great wine.

Code for the International Classification ailment of the 10th look

• E23.2 Lack of blood diabetes.
• N25.1 Nephrogenic non-congenital diabetes

Epidemiology

extension of untruths red diabetes in the population behind the growing dzherels of the warehouse 0.004-0.01%.

prophylaxis

Prevention is not broken up.

screening

Do not screen.

Classification

• V CLINIC PRACTICE There are three main types of non-bloody diabetes:
• central (hypothalamic, hypophyseal), accumulation of damage to the synthesis of or secretion of vasopresin;
• nephrogenic (nirkovy, vasopresin-resistant), which is characterized by nirok resistance to vasopresin;
• Parvin polіdipsіya: torn down, if patologіchna zhaga (dіpsogennaya polydipsia) abo compulsive Bazhannya Peattie (psychogenic polіdipsіya) i pov'yazane of CIM nadmіrne spozhivannya Vod prignіchuyut fіzіologіchnu sekretsіyu vazopresinu in rezultatі privodyachi to harakternoї symptoms netsukrovogo dіabetu at tsomu at degіdratatsії organіzmu synthesis vazopresinu update.

Also, the visions and the inshes, the big ones, the type of non-bloody diabetics:

• gestational, dressings with an increase in the activity of the placenta enzyme - argininaminopeptidazi, ruinu vasopresin;
• functional: in children of the first fate of life and understanding of the immaturity of the concentration mechanism of low and increased activity of phosphodiesterases, so that it can lead to rapid deactivation of the receptor to vasopressin of the hormone low;
• iatrogenic: admit the consumption of diuretics to the whole type, recommendations for the living of the great debates of the country.

For heavy interruption:

• mild form - vision up to 6-8 l / day without treatment;
• middle - vidіlennya 8-14 l / day without treatment;
• important - vision more than 14 liters / day without treatment.

For the stage of compensation:

• compensation - in case of spraga and polyuria in general, do not turbulence;
• subcompensation - in case of lіkuvannі, thunderbolt sprague and polyuria throughout the day, which is infused into the widespread activity;
• decompensation - spraga and polyuria are saved in case of illicit illness and slow down the flow of water on a wide range of activities.

Ethiology

Central non-bloody diabetes

Prizheniy.

◊ Semeiniy:

• autosomal dominant;
• DIDMOAD-syndrome (diagnosis of diabetes mellitus and non-congenital diabetes, atrophy of healthy nerves and neurosensory deafness - Diabetes Insipidus, Diabetes Mellius, Optic atrophy, Deafness).

◊ Damaged development of the brain - septooptic dysplasia.

nabutia:

• trauma (neurosurgical operations, craniocerebral trauma);
• puffs (craniopharyngoma, germinoma, glioma and in.);
• metastasis in the hypochondria of fluffy localizations;
• hypoxic / IPM;
• lymphocytic neurohypophysis;
• granuloma (tuberculosis, sarcoidosis, histiocytosis);
• infection (congenital cytomegalovirus infection, toxoplasmosis, encephalitis, meningitis);
• sudin pathology (aneurysm, malformations of sudin);
• idiopathic.

Nephrogenic non-congenital diabetes

Prizheniy.

◊ Semeiniy:

• X-pov'anne sedation (defect in the V2 receptor gene);
• autosomal recessive decline (AQP-2 gene defect).

nabutia:

• osmotic diuresis (glucosuria in case of sugar diabetes);
• metabolic damage (hypercalcemia, hypocalcium);
• chronic nirkova lack;
• post-obstructive uropathy;
• lykarski zasobi;
• vimivannya elektrolіtіv s interstitіyu nirka;
• idiopathic.

pervinna polydipsia

• Psychogenic - the debut or manifestation of neuroses, manic psychosis or schizophrenia.
• Dipsogenic - pathology to the center of the hypothalamus sprague.

pathogenesis

Pathogenesis of central diabetics: impaired secretion or vasopresin on the V2 receptor (receptor for vasopresin type 2) of the head cells of the small tubules to produce before the “vodovuvannya” channel of vasopressin-water is used. , і, also, there is no reabsorption of water. At the same time, the water at the great number is consumed with the cross, wickedly hot water and, like a legacy, spragu.

key picture

The main manifestation of non-blooming diabetes is polyuria (seeing more than 2 l / m2 for more than 40 ml / kg for more for older children and older adults), polydipsia (close to 3-18 l / day) and interfacing with them. Characteristically, the transition of simple cold / kryzhano water. It can be dryness of shkiri and slimy, change in saliva and sweat. Appetite, as a rule, decreases. systolic arterial vise(AT) may be normal or decrease in the presence of a characteristic increase in diastolic AT. The severity of the disease, so that the swelling of symptoms, lies at the level of neurosecretory deficiency. With a frequent deficiency of vasopressin, clinical symptoms may not be very vivid and appear only in the minds of nutritional deprivation, or overwhelmed by the ridini (hikes, excursions, speculative weather). In connection with those who need glucocorticoid therapy for seeing water, because they do not take revenge on electrolytes, the symptoms of a central diabetes mellitus can be masked by a hypothermic hypothermic lack of therapy, and in such a type of maneuver caused by glucose

diagnostics

anamnesis

When taking the anamnesis, it is necessary to clarify the triviality and the severity of symptoms in patients, the manifestation of polydipsia, polyuria, early breakdowns in carbohydrate metabolism and the nature of the diabetic diabetes.

physical condition

When you look around, you can see symptoms of dehydration: dryness of the skin and mucous membranes. The systolic AT is normal, or there are trochais of reductions, the diastolic arterial grip of displacement.

Laboratory dosage

For non-congenital diabetes is characterized by an increase in blood osmolality, hypernatrium, gradually low osmolality (<300 мосм/кг) или относительная плотность мочи (<1005). Для первичной полидипсии - снижение осмоляльности крови и гипонатриемия на фоне такой же низкой осмоляльности и относительной плотности мочи. Необходимо проведение клинического анализа мочи, а также определение концентрации калия, кальция, глюкозы, мочевины и креатинина в биохимическом анализе крови для исключения воспалительных заболеваний почек и наиболее частых электролитно-метаболических причин возникновения нефрогенного несахарного диабета.

It has been shown that there is a genetic dosage during the adolescence for the declining nature of the disease.

instrumental doslіgennya

Magnetic resonance imaging (MRI) of the brain for diagnostics of the causes of central non-congenital diabetes (puffiness, inflammatory disease, granulomatous disease of hypothalamus and hypophysis, etc.).

In case of nephrogenic non-congenital diabetes:

• dynamic test of the function of nirok (swiftness of glomerular filtration, scintigraphy nirok and іn.);
• ultrasound doslіdzhennya (UZD) nirok.

Differential diagnosis

Accurate differential diagnosis of the main three forms of non-bloody diabetics is a principle for the choice of a diabetic, as well as for a fake joke, a potent cause of illness and pathogenetic abuse. There are three stages in the foundation.

• At the first stage, the manifestation of hypotonic polyuria is confirmed - the appearance of a section of more than 2 l / m2 for additional or 40 ml / kg for additional for older children and older adults with a living rate of less than 1000 or less than 300 mosm / kg.
• At the other stage, conduct a test for dry eating (vinyatka primary polydipsia) and desmopressin test (for the subtype of central and nephrogenic types of non-diabetic diabetes).
• On the third - the joke of the reasons, scho wikklikal zhvoryuvannya.

Wikipedia:

• taking shelter for osmolality and sodium;
• I am grabbing for a viznachennya obsyach and osmolality;
• honor the sick;
• vimіryat arterial vise and pulse.

Pinch the sample at:

• spend more than 3-5% oil;
• intolerable jade;
• with an observationally important patient's age;
• adjusted sodium and osmolality of blood between norms;
• adjusted osmolality of the section at 300 mosm / kg.

Conducting a dry eating test in outpatient minds.

Tilki! for patients in a stable state, with an increase in polydipsia manifestation and up to 6-8 l / day. Meta is the removal of the most concentrated (residual) portion of the sech.

Carrying out technique.

• Ask the ailing one to be surrounded by the time of birth for that hour, if you can show it. Naybіlsh by hand a cob of meat for a few years before sleep and before an hour of sleep.
• The patient picks up the test when the natural need is determined. It’s when the night is awakened, when only the rest of the port itself is brought to the analysis, only the rest of the port itself will be brought in the minds of the concentration of the life itself.
• Before carrying out the analysis, I cut it in a closed view into the refrigerator.
• The test can be pinned by the patient himself, taking care of his self-esteem, so that for the analysis of the wine, give the very rest of the section to the renewal of the pitt.
• Osmolality / osmolality starts in the last port of this section: an indicator that changes 650 mOsm / kg, allowing for some genesis of non-bloody diabetes.

Desmopressin test (for differential diagnostics central and nephrogenic forms of non-bloody diabetes) according to G.L. Robertson.

It is carried out for patients with a polydipsia onset, optimally for a test with dry eating.

Carrying out technique:

• ask the sick person to pick up the sečovy mikhur;
• inject 2 μg desmopressin internally, internally, or intravenously, or 10 μg intranasally, or 0.1 mg of desmopressin tablets, until further dehydration;
• patients are allowed to drink and drink (obsyag vipivatsya rіdini is not guilty of overwhelming obsyagu vіdіlenoї sechі pіd hour of dehydration);
• in 2 і 4 years, I will take a swear і osmolality;
• take shelter on the offensive wound for the appointment of sodium and osmolality;

In the majority of patients, the functional camp in the center of sprague is more saved, in connection with the normativeness and normal osmolality of the blood, it is accepted by the way of living the life, adequately at the expense. Biochemical changes become obvious only when there is an adjacent access of ailments to the water and in case of pathology to the center of the sprague. For such patients, for the diagnosis of "non-congenital diabetes" (to prevent psychogenic and dipsogenic polydipsia), it is necessary to carry out a test with dry eating. Pid hour degіdratatsії, nezvazhayuchi on zmenshennya ob'єmu tsirkulyuyuchoї krovі, znizhennya klubochkovoї fіltratsії i pіdvischennya osmolyalnostі i natrіyu krovі, polіurіya zberіgaєtsya, kontsentratsіya sechі i її osmolyalnіst mayzhe not zrostayut (vіdnosna schіlnіst sechі 1000-1005, osmolyalnіst sechі nizhche plasma osmolality, tobto nizhche 300 mOsm / kg. To produce up to the development of symptoms of anxiety: severe weakness, tachycardia, hypotension, collapse. to adjust the concentration of sodium, hemoglobin, excess nitrogen, the amount of erythrocytes.

Shown before consulting fahivtsiv

In case of adolescence for the appearance of pathological changes in the hypothalamic-hypophysis region, consultations of a neurosurgeon and an ophthalmologist are indicated; in case of pathology of the secular system - a urologist, and in case of a confirmed psychogenic variant of polydipsia, it is necessary to refer to a consultation before a psychiatrist / neuropsychiatrist. If you are susceptible to the development of central non-vascular diabetes within the framework of the DIDMOAD-syndrome, an additional treatment is carried out for the manifestation of sugar diabetes, an ophthalmologist for the prevention of atrophy of healthy nerves, an otorhinolaryngologist - for neurosensitivity.

Butt formulatory diagnostics

Central non-bloody diabetics of the middle stage of gravity, compensation.

lykuvannya

In case of a confirmed unhealthy diabetics, it is necessary to establish a dietary regimen (depending on consumption / consumption).

In case of central noncancerous diabetes, a synthetic analogue of vasopresin, desmopressin, is used. Desmopressin activates only the V2 receptor for vasopressin in the head cells of the brain tubules. In porіvnyannі of vazopresinom, desmopressin volodіє Mensch virazhenoyu dієyu on gladkі m'yazi sudin i vnutrіshnіh organіv, volodіyuchi bіlshoyu antidіuretichnіy aktivnіstyu and takozh bіlsh stіyky to enzymatic ruynuvannya (in fact i chislі for argіnіnamіnopeptіdazi placenta tobto Yogo mozhna zastosovuvati with progestogen tipі netsukrovogo dіabetu ), which is surrounded by changes in the structure of the molecule.

In this hour, desmopressin is released in pharmaceutical forms. The drug should be consumed 2-3 times per dose in cob doses of 0.1 mg for tablets, 60 mcg for tablets for oral use, or 1-2 times per dob in cob doses of 10 mcg (1 dose) for intranasal dosed spray і 5-10 μg (1-2 drops) for intranasal drops. We reduce the dose of the drug until it reaches the optimum - minimum for the control of excess sprague and polyuria.

The treatment of congenital nephrogenic non-congenital diabetes should be carried out with the help of thiazide diuretics (hypotiazide 50-100 mg / dose) and non-steroidal anti-epileptic drugs (indomethacin 25-75 mg / day, ibuprofen 600-800 mg / day). In case of a nephrogenic nefrogenic diabetic in the first place, carry out a lykuvannya of a congenial illness.

further away

At the same time, desmopresin therapy is mainly chosen according to the patient's self-esteem, compensating for the loss of life in the functional burial center of the sprague. At the same time, it is recommended to periodically evaluate the osmolality of blood plasma and / or the concentration of sodium in the blood, vimir of the arterial clutch, the appearance of the appearance of swelling for the prevention of overdose / lack of the drug. Naybilsh important patients - ailments with destructive spragi. Nutritional regime with adiptic variation of such damages is recommended either for fixing, or for storing up a lot of vision. In case of severe dipsogenic component of non-congestive diabetes (NOT in case of primary polydipsia!) Desmopresin can also be used more frequently, so that by periodically skipping a dose of the drug for augmenting the development of water intoxication. In patients, if MRI does not show pathology of hypothalamic-hypochondriacal region in case of central form of non-congestive diabetes, it is recommended to repeat MRI after 1, 3 or 5 years because of the appearance of negative dynamics of central neurology. hypothalamic-hypophyseal region in a few rocks.

control zavdannya

zavdannya 1

For a patient, 46 rocks, polydips, polyuria stretching 3 ms. Dani skargi appeared rapt, the nutritional regimen was not changed, the patients' drugs were not removed. In the test of Zimnitskii, the decrease in the animal's vagina, when the test was carried out with dry eating, it did not feel anything at all. Is it possible to diagnose the form of non-bloody diabetes in this patient?

A. Gestatsiyny.

B. Central.

V. Funktsionalny.

G. Iatrogenic.

D. All pererakhovani vishche.

The correct statement is B.

The patient may have the presence of a central non-bloody diabetes, such as the impairment of the synthesis of or secretion of vasopressin. Gestational non-uterine diabetes develops in women and in dressings with an increase in the activity of the placenta enzyme - argininaminopeptidazi, ruinu vasopresin. Functional non-hyperactive diabetes mellitus in children of the first fate of life and understanding of the immaturity of the concentration mechanism of low and increased activity of phosphodiesterases, so that it can lead to a high level of deactivation of the receptor to the reduction of the receptor. For iatrogenic non-bloody diabetes, it is characteristic of the presence of prompts for the stasis of diuretics, and of the recommendations for living of great communities of birth.

zavdannya 2

Patient, 30 years old, vipivav to dob up to 7 liters of birth, the signs of desmopressin, epizodi of polydipsia are periodically repeated at the time of the trip, but sometimes the patient’s camp and the decrease in the rate of praezdatnost. What is the diagnosis of this patient?

A. Non-uterine lung diabetics, compensation.

B. Low-blood diabetes of the lung, subcompensation.

B. Non-uterine diabetes of the middle stage, decompensation.

D. Non-fertile diabetics of the middle stage, compensation.

D. Non-fertile diabetes of an important stage, compensation.

The correct statement is B.

Oskilki for an easy form of non-bloody diabetes without addiction is characteristic of seeing up to 6-8 liters for dobu; for medium - polyuria up to 8-14 liters; for important - a vision over 14 liters, for a patient - a slight form of becoming ill. At the stage of compensation in the case of spraga and polyuria, there is generally no turbulence; in case of subcompensation on the smallest of life, they throw up sprague and polyuria throughout the day, so they pour into the ever-increasing activity; In the stage of decompensation, patients with sprague and polyuria are saved when taking drugs and spend a lot of infusion on a daily basis.

zavdannya 3

In a child of 2 births, a partial atrophy of the discs of healthy nerves was revealed, through the risk of dullness was diagnosed, even after 3 births of a type 1 diabetes mellitus. In the Danish hour of patrons 8 rockyv, skargi appeared on sprague, polyuria. Sugar blood with a stretch of 5 to 9 mmol / l, glucosylation of hemoglobin - 7%. In the analysis of the section, aglucosuria, the pitoma of the vaga - 1004, the block is not revealed. The analysis of the slaughter for microalbuminuria is negative. The osmolality of the section is 290 mosm / kg. What diagnosis can be given to this patient?

A. Diabetic nephropathy.

B. DIDMOAD syndrome.

B. Psychogenic polydipsia.

D. Decompensation of diabetic diabetes (osmotic disease).

D. Fanconi syndrome.

The correct statement is B.

The patient is characterized by the following syndromes - diabetics (Diabetes Insipidus), diabetics (Diabetes Mellius), atrophy of healthy nerves (Optic atrophy), sensorineural stiffness (Deafness) - DIDMOAD-syndrome. Diabetic nephropathy develops in case of type 1 diabetes mellitus in a larger period of time and is characterized by the manifestation of microalbuminuria. For psychogenic polydipsis, it is not typical for a congenital diabetes or a non-congenital diabetes with deafness and atrophy of the discs of healthy nerves. The patient has good compensation for diabetes, he has an osmotic disease. Fanconia's syndrome (ailments de Toni-Debre-Fanconi) is characterized by impairment of tubular reabsorption of phosphate, glucose, amino acids and bicarbonate;

zavdannya 4

The patient, 21 rocky, had skargi for nudota, blues, head beats, sprouts and polyuria. Observed in the gastroenterological center - pathology from the side of the organs shlunkovo-intestinal tract not known. The mill has gone bad - spraga and polyuria have grown, a bit of vipito rіdini in the amount of up to 8 liters, a practically permanent head bіl, supravodzhuvana bluing, also means the loss of lateral fields of discs. When carrying out the conditioning, a decrease in the natal vagi in the rankovy portion of the section to 1002 was revealed, the osmolality of the blood was 315 mosm / kg, the osmolality of the section was 270 mosm / kg. Sugar blood for natsche - 3.2 mmol / l. For ultrasonic scanning nirok zmіn rozmіrіv nirok, budov and cup-bowl system is not revealed. Do you need to spend a patient in the first place?

А.

B. Test for dry eating.

B. Genetic analysis of blood for detecting a defect in the AQP-2 gene.

D. MRI of the brain.

D. Excretorn urography.

Correct statement - G.

At the patient key picture uncrowded diabetes and neurological manifestation (headache, tediousness, persistent changes on the day and in the past), so that you can perceive the central form of uncrowded diabetes due to the growth of puffin. To verify the diagnosis, an MRI scan of the brain is required. Low blood glucose levels and blood glucose levels, as well as normoglycemia in the heart, lead to diabetes mellitus, and it is not necessary to carry out an extended glucose test. Genetic analysis of blood is carried out for the prevention of decaying forms of non-congenital diabetes, associated with the pathological gene AQP-2, so that the synthesis of cyclic adenosine monophosphate and adenylate cyclase is necessary in the cells of non-circulating canals. ... For ultrasonic examination, none of the dimensions and structure of them are damaged, but the wrinkling of the micros is not visible, and not the appearance of an extraordinary urography.

zavdannya 5

The patient, 38 years old, has a polyurethane and polydipsis with scarves for 6 months and has a bad diabetes. What kind of diagnostic plan is to blame for the storage at the first stage of the situation?

A. Zagalny blood analysis, zagalny analysis of blood, ultrasound nirok.

B. Zagalny blood analysis, zagalny analysis of blood, MRI of the brain.

V. Zimnitsky's test, analysis of the slaughter according to Nechiporenko, analysis of blood for tsukor.

G. Zimnitsky's test, the value of the osmolality of blood and sech.

D. Zimnitskiy's test for the value of the blood sample and blood osmolality.

The correct statement is V.

If you are susceptible to non-congenital diabetes at the first stage of diagnostics, the menstrual test is confirmed by the presence of hypotonic polyuria - the appearance of a slit more than 2 l / m2 for up to 40 ml / kg for more senior children and older children at least 1000 300 mOsm / kg (up to the last section for osmolality or osmolality grafts).

zavdannya 6

Patients, 23 years of age, with an adolescent for non-congenital diabetes, it is planned to carry out a test for dry eating. Likar will help the child about those who, on the day before the last day, will be well-educated, then the blood analysis is carried out for the evaluation of the level of sodium and osmolality and the test of the slaughter for the evaluation of the general and osmolality. Patients are harvested for pity, permits light food without ridini (made an egg, often porridge), if possible, it is recommended to use it as a food. For an hour, the test will be carried out for monitoring of AT and pulse, after 6 years from the ear of the test, it will be tested for shelter and slaughter for osmolality. Any inaccuracies in the information provided?

A. There is no need to carry out a test before the cob.

B. On the ear of the test, it is not possible to get shelter and cut for osmolality.

B. During the test, the patient should not be surrounded by the patient.

D. Control of AT and pulse is carried out dermal 15 min for 6 hours.

D. Break through and blood should be continued at intervals of 1-2 hours.

The correct statement is D.

Protocol of classical test with dry eating (dehydration test) according to G.L. Robertson (for the approval of non-bloody diabetes).

Wikipedia:

▪ taking shelter for osmolality and sodium;

▪ I am grabbing the osmolality for the sake of value;

▪ honor the sick;

▪ vimіryaty arterial vise і pulse.

Nadal in equal intervals of an hour in the fallowness to the camp of the ailing one after 1 or 2 hours of repetition.

Try the hour: a sick person is not allowed to drink, but it is also not allowed to drink (accept, holding out the first 8 years of testing); When bathing, she is not guilty of the vengeance of rich water and easily absorbed carbohydrates, eggs, cereal bread, low-fat varieties of meat, ribi can be boiled.

zavdannya 7

Patient, 5 rockyv, a test is carried out with dry food. A slapstick is disgusting to endure until it’s lingering, it’s constantly vimaga, it’s crying, it’s impossible to be calm, it’s because the temperature is up to 38.6 ° C, and it’s boring. When a baby is well-known to the ear of the sample - the weight of 18 kg, after 3 years, the sample of the sample of the weight dropped to 17.4 kg. The osmolality of the cross section is 270 mOsm / kg per ear of the sample і 272 mOsm / kg after 3 hours. Likar pinched the sample. Yak vintages will NOT be shown for a test at the patient?

A. An important stan ditini.

B. Decrease in mass.

B. The increase in the osmolality of the section.

G. Spraga bends.

D. All perakhovan vishche.

The correct statement is V.

The classic test for dry eating should be pinched when the onset of changes appears:

▪ at a consumption of more than 3-5% oil;

▪ intolerable jade;

▪ in case of an observationally important patient's status;

▪ adjustment of sodium and osmolality of blood between norms;

▪ Adjustment of the osmolality of the section up to 300 mOsm / kg.

Thus, the height of the adjustment of the osmolality of the section will NOT be indicated for the adjustment of the test with dry eating.

zavdannya 8

Patients, 47 years old, a test for dry eating was carried out in advance for non-uterine diabetics, as a result of which there was no indication of an increase in the baby's vagina and the osmolality of the blood and a decrease in the osmolality of the blood. Schedule desmopressin assay. In reality, the form of the preparation is tabletted. Yaku a dose of slid vibrati for carrying out a test of a given patient?

Correct statement - G.

When carrying out a desmopressin test (for differential diagnosis of central and nephrogenic forms of non-congenital diabetes) according to G.L. Robertson is injected with 2 mcg desmopressin internally, internally, or intravenously, or 10 mcg intranasally, or 0.1 mg desmopressin in tablets before re-wetting.

zavdannya 9

Patients, 28 years old, with gestagenic non-congenital diabetes, signs of a synthetic analogue of vasopressin - desmopressin. What is the reason for desmopressin from vasopressin to allow vikoristovuvati in case of gestagen unsuccessful diabetes?

A. Insignificant inflow on the smooth ointment of the Sudin.

B. Greater stiffness to enzymatic ruinuvannya.

B. The availability of depot forms, which allows the introduction of 1 time per add.

G. Mensha Antidiuretic activity.

D. The rate of teratogenic activity for the period.

The correct statement is B.

Desmopressin activates only the V2 receptor for vasopressin in the head cells of the brain tubules. At porіvnyannі vazopresinom of desmopressin volodіє Mensch virazhenoyu dієyu on gladkі m'yazi sudin i vnutrіshnіh organіv, volodіyuchi bіlshoyu antidіuretichnіy aktivnіstyu and takozh bіlsh stіyky to enzymatic ruynuvannya (in addition to chislі i argіnіnamіnopeptіdazi placenta tobto Yogo mozhna zastosovuvati at gestagen tipі netsukrovogo dіabetu) , which is surrounded by changes in the structure of the molecule. Do not use a depot form of the drug. There is no information about teratogenic infusion of vasopressin and desmopressin on the plate.

zavdannya 10

Дівчинці, 4 years, the diagnosis of congenital nephrogenic non-bloody diabetes. Do you need to recommend a pacinttsi data from the hovering schemes below?

A. Desmopressin 100 mcg / day in the middle and indomethacin 25 mg / day.

B. Hydrochlorothiazide 100 mg / day and desmopressin 100 μg / day.

B. Indomethacin and ibuprofen in vikovyh doses.

G. Hydrochlorothiazide and ibuprofen.

D. Hydrochlorothiazide in the middle and furosemide in the interior.

Correct statement - G.

Treatment of congenital nephrogenic non-congenital diabetes should be carried out with supplemental thiazide diuretics (hydrochlorothiazide 50-100 mg / dob) and non-steroidal anti-apalacia (indomethacin 25-75 mg / day, ibuprofen 600-8) In case of a nephrogenic nefrogenic diabetic in the first place, carry out a lykuvannya of a congenial illness.

zavdannya 11

Patients, 38 years, after the performed operative treatment of craniopharyngeomy, diagnostics of non-congenital diabetes, and it is planned to identify desmopresin in the presence of pills. Is Yaka Pochatkova a dose of guilty, but was it taken in a given situation?

The correct statement is B.

Desmopressin in case of poor diabetes mellitus should be consumed 2-3 times per dose in cob doses of 0.1 mg for tablets, 60 mcg for tablets for oral doses or 1-2 times per dose in cob doses of 10 mcg (1 dose) for intranasal dosed spray і 5 -10 μg (1-2 drops) for intranasal drops. We reduce the dose of the drug until it reaches the optimum - minimum for the control of excess sprague and polyuria.

List of Literature

1. Dzeranova L.K., Pigarova E.A. Central non-congenital diabetes: modern aspects of diagnostics and treatment // Likuyuchiy likar. - 2006. - No. 10. - S. 44-51.

3. Robertson G.L. Diabetes insipidus // Endocrinology Metab. Clin. N. Am. - 1995. - Vol. 24. - P. 549-572.

4. Robinson A.G., Verbalis J.G. The posterior pituitary // Williams textbook of endocrinology; ed. by P.R. Larsen, H.M. Kronenberg, S. Melmed, K.S. Polonsky. - 10th ed. - Philadelphia, 2003. - P. 281-330.

5. Pigarova E.A. Chapter 13. Infection of the neurohypophysis. Clinical neuroendocrinology ed. Didova I. І. - UP Print, M .: 2011 .-- p. 239-256.

RCHRH (Republican Center for Development of Health Protection of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2013

Diabetes mellitus (E23.2)

endocrinology

General information

Short description

hardened

protocol of the expert committee

food development, protect health of the Ministry of Health of the Republic of Kazakhstan

non-bloody diabet(ND) (lat.Diabetes insipidus) - enlightened, degraded synthesis, secretion, or even vasopressin, which appears as an extraordinary great number of cuts from low salt polymeric
Epidemiology . The prevalence of ND in young populations varies from 0.004% to 0.01%. There is a light tendency until the growth of the width of the ND, the sprout, for the rakhunok of the central form; Vvazhaєya, scho ND, however, often suffers from both women and men. The peak of sickness falls on 20-30 years.

Name of the protocol:non-bloody diabet

Code (codi) according to ICD-10:
E23.2 - Non-blood diabetes

Date of release to the protocol: April 2013 rock.

Fast, as vikoristoyutsya in the protocol:
ND - non-bloody diabetes
PP - primary polydipsia
MRI - magnetic resonance imaging
AT - arterial vise
SD - cukroviy diabet
UZD - ultrasound doslіgennya
Shlunkovo-intestinal tract - shlunkovo-intestinal tract
Refinery - non-steroidal prototypes
CMV - cytomegalovirus

Category of patients: children and women from 20 to 30 years of age, a history of trauma, neurosurgical involvement, pukhlin (craniopharyngoma, germinoma, gloma, etc.), infectious diseases (congenital CMV-infection)

Coristas to the protocol: clinical therapist, doctor-endocrinologist of the polyclinic about the hospital, neurosurgeon to the hospital, traumatologist of the hospital, medical pediatrician.

Classification

CLINIC CLASSIFICATION:
Naybils are often encountered:
1. Central (hypothalamic, hypophyseal), accumulation of impaired synthesis and secretion of vasopressin.
2. Nephrogenic (nirkovy, vasopresin - resistant), characterized by nirok resistance to vasopresin.
3. Primary polydipsia: collapse, if pathological thrusts (dipsogenic polydipsia) or compulsive symptoms of pity (psychogenic polydipsia) and due to the overwhelming survival of water and reduce the sequelae of degenerative results synthesis of vasopressin is introduced.

Also see and are born type of diabetics:
1. Gestagenium, dressings with an increase in the activity of the placenta enzyme - argininaminopeptidazi, ruinu vasopresin. When the situation is flat, the situation is normalized.
2. Functional: in children of the first fate of life and understanding of the immaturity of the concentration mechanism of low and increased activity of phosphodiesterase type 5, so that it can lead to the rapid deactivation of the triple receptor to low vasopressin.
3. Iatrogenic: stagnation of diuretics.

Classification of ND according to the importance of overload:
1.mild form - visible up to 6-8 l / day without treatment;
2. middle - see section up to 8-14 l / day without treatment;
3. Important - seeing more than 14 liters / day without treatment.

Classification of ND by the level of compensation:
1.compensation - do not turbulent when spraga and polyuria are detected;
2. subcompensation - in case of lіkuvannі it is thrown at the time of the day;
3. decompensation - spraga and polyuria are taken.

diagnostics

Switching of the main and additional diagnostic entries:
Check in before the scheduled hospitalization:
- Zagalny analysis of the slaughter;
- biochemical analysis of blood (calories, sodium, calciferous calcium, calcium ionization, glucose, blood sugar, sechovina, creatinine, blood osmolality);
- assessment of dyuresis (> 40 ml / kg / day,> 2l / m2 / day, section osmolality, relative density).

Basic diagnostics come in:
- Sample with dry food (dehydration test);
- Test with desmopresin;
- MRI of the hypothalamic-hypophyseal zone

Dodatkovі diagnostics enter:
- ultrasound nirok;
- Dynamic test will become a function of nirok

Diagnostic criteria:
Skargi and anamnesis:
The main manifestations of ND are polyuria (seeing more than 2l / m2 for more or 40 ml / kg for dob for older children and adults), polydips (3-18l / dob) and related sleep disturbance with them. Characteristically, the transition of simple cold / kryzhano water. It can be dryness of shkiri and slimy, change in saliva and sweat. Appetite, as a rule, decreases. The variability of symptoms lie at the level of neurosecretory deficiency. In case of partial deficiency of vasopressin, clinical symptoms may not be very viral and manifest in the minds of nutritional deprivation or overwhelming loss of ridin. When taking an anamnesis, it is necessary to clarify the triviality and severity of symptoms in patients, the manifestation of symptoms in polydipsia, polyuriasis, diabetes in relatives, a history of trauma, neurosurgery, etc. , toxoplasmosis, encephalitis, meningit).
Newborns are not happy with the basic picture of being ill. In such patients, it is possible to prevent the loss of oil, dry and blida shkira, The visibility of the sleep and the visibility, the adjustment of the temperature of the room. The stench can cause water to pass through breast milk, and sometimes it becomes symptomatic only when the baby is seen from the breasts. The osmolality of the slice is low and rarely changes at 150-200 mosmol / kg, but the polyuria is only in the case of a child's birth. Children have such early vik even more often and rapidly develop hypernatrium and hyperosmolality of blood with sudomas and coma.
In older children, on the first plan in the clinical symptomatology, there may be symptoms of sprague and polyuria; Children grow badly and gain vagu, they often have bloating when they get sick, they have an appetite, they tend to suffer from hypotonic stun, constipate, get clogged psycho development... Obvious hypertonic dehydration of the wine only at the time of day access to the country.

Physical details:
When you look around, you can see symptoms of dehydration: dryness of the skin and mucous membranes. The systolic AT is normal, or there are trochais of reductions, the diastolic arterial grip of displacement.

Laboratory Doslidzhennya:
For tribute extravagant analysis Sechі - won’t be bad, do not take revenge on any pathological elements, with a low tolerance (1,000-1,005).
A test is carried out behind Zimnitskiy to determine the concentration of buildings. If in any case of a pitoma of a slice of 1.010, then the diagnosis of ND can be made, a protest of memory, the presence of a pitom in a slice and a bottle of a pitom of a slice.
Plasma hyperosmolality - at 300 mosmol / kg. At normal, the osmolality of plasmas becomes 280-290 mosmol / kg.
The hypo-osmolality of the section (less than 300 mosmol / kg).
Hypernatrium (more than 155 meq / l).
In the case of the central form of ND, a decrease in the level of vasopressin in the blood is indicated, and in the case of nephrogenic form, in the norm, or even if there is no change.
dehydration test(Dry food test). Dehydration test protocol according to G.I. Robertson (2001).
Dehydration phase:
- taking shelter for osmolality and sodium (1)
- I am grabbing a swearing and osmolality (2)
- vimiryati vagu of the patient (3)
- control of arterial vise and pulse (4)
Nadal in equal intervals of an hour in the fallowness from the patient's camp in 1 or 2 years, or repeat points 1-4.
Patients are not allowed to drink, but they are also bridged, at least during the first 8 years of the test; When she was bathing, she was not guilty of revenge of being richly driven and easily consumed in carbohydrates; perevazhnі boiled eggs, grain bread, low-fat varieties of meat, ribi.
Try to lean back at times:
- consume more than 5% oil
- unbearable jade
- an observationally important patient
- adjustment of blood sodium and osmolality between norms.

Desmopresin test... The test is carried out immediately after the end of the dehydration test, if the maximum capacity of the secretion / endogenous vasopressin is reached. The patient is given 0.1 mg of tableted desmopressin before re-absorption or 10 mcg intranasally in a spray. The osmolality of the section changes to the intake of desmopresin after 2 or 4 years after. In the course of the test, the patient is allowed to drink, but not more than 1.5 times the volume of this video, on the dehydration test.
Interpretation of the results in the test with desmopressin: Normally, in case of primary polydipsia, the concentration of blood is 600-700 mosmol / kg, the osmolality of the blood and sodium is lost in the normal range, self-indulgence. Desmopressin practically does not increase the osmolality of the section, since the maximum concentration is already reached.
With central ND, the osmolality of the blood in the course of dehydration does not outweigh the osmolality of the blood; With the introduction of desmopresin, the osmolality of the section increases by 50% more. In case of nephrogenic ND, the osmolality of the blood and sodium to move, the osmolality of the cross section is less than 300 mosmol / kg yak, and with the central ND, if the osmolality of the cross section is not practically moved up to 50% if it is vicious with desmopresin.
Interpretation of the results of samples is summarized in tab. ...


Instrumental doslіgennya:
Central ND is used as a marker of the pathology of the hypothalamic-hypophysis region. MRI of the brain є using the vibor method for diagnostics of the hypothalamic-hypophysis region. With central ND, the method is low overvag in the case of CT scans and other methods of visualization.
MRI of the brain is used to identify the causes of central ND (puffiness, inflammatory disease, granulomatous disease of hypothalamus and hypophysis, etc.). in dynamism, so it’s not easy to trample, if the central ND appears for a few rocky before the churning out

Shown for consulting fahivts:
With an adolescence for the manifestation of pathological changes in the hypothalamic-hypophysis region, consultations of a neurosurgeon and an ophthalmologist are indicated. In case of revealed pathology of the secular system - a urologist, and in case of a confirmed psychogenic variant of polydipsia, it is necessary to refer to a consultation before a psychiatrist or a neuropsychiatrist.

Differential diagnosis

It is carried out between three main stanes, which are supported by hypotonic polyuria: central ND, nephrogenic ND and primary polydipsia. Differential diagnosis is based on 3 main stages.

Likuvannya beyond the cordon

Take a lykuvannya in Korea, Izrail, Nimechchin, USA

Otrimati the consultation on medturism

lykuvannya

Cіlі lіkuvannya:
The change in the turn of the sprague and polyuria to such a world, as it allowed the patients to lead a normal way of life.

Likuvannya tactics:
Central ND.
Desmopressin is the preferred drug. More patients have to prescribe desmopressin in tablets (0.1 and 0.2 mg each), if they want to continue successfully using desmopressin intranasal spray. I will look at individual pharmacokinetic features in the region, it is important to start the triviality of a single dose of the drug individually in a skin patient.
Desmopresin therapy in the form of tablets is indicated in a cob dose of 0.1 mg 2-3 times in the middle 30-40 minutes before or after 2 years. The average dose of the drug is varied from 0.1 mg to 1.6 mg per dose. One-hour reception of їzhі can reduce the level of moisture from the shlunkovo-intestinal tract by 40%. When intranasal zastosuvanny pochatkova dose to become 10 mcg. When sprinkling the spray, it spreads along the front surface of the mucous nasal emptying, which will prevent a greater concentration of the drug in the blood. The need for the preparation is varied from 10 to 40 mcg for dobu.
The main meta liquefaction with desmopressin is the addition of a minimally effective dose of a drug for the suppression of sprague and polyuria. Do not look at the nature of the therapy for the adjustment of this kind of slaughter, especially in the skin analysis for the analysis of the slaughter for Zimnitskiy, though not all the patients from the central ND in the same class normal indicators concentrated function of nirok (physiological variability of concentration throughout the day, concomitant pathology nirok and іn.).
Non-bloody diabetics with inadequate spragoy.
With a change in the functional center of the sprague towards the lowering of the threshold of sensitivity, hyperpsy, the patient is sick to the development of such an accelerated therapy with desmopressin as water poisoning, which is potentially life-threatening. Such patients are periodically advised to pass the medication in order to see the overwhelmed excess of age or fixation of the medication.
Stan of Adipsia with central ND can be manifested in cases of epizodes of the hypothesis of hypernatria. The conduct of such children will come with a fixed communication with a child, or with recommendations to take a child for a whole lot of pictures + 200-300 ml of a child. Patients in the loss of a sprague need a special dynamic control to become more powerful, and in some cases, more often, based on osmolality and sodium blood.

Central ND for surgical interventions on hypothalamus or hypophysis due to head injuries.
Ingestion in 75% of cases is transient, and in 3-5% - triphasic extension (I phase (5-7 days) - central ND, II phase (7-10 days) - syndrome of inadequate secretion of vasopressin, III phase - persistent central ND ). Desmopresin is indicated for the manifestation of symptoms of non-congenital diabetes (polydipsia, polyuria, hypernatria, blood hyperosmolality) at a dose of 0.05-0.1 mg 2-3 times as needed. Skin 1-3 days to assess the need for the drug: to skip the Chergov dose, to control the renewal of symptoms of non-diabetic diabetes.
Nephrogenic ND.
For the reduction of symptomatic polyuria, thiazide diuretics and low sodium intake are used. Antidiuretic effect in this type of reasoning to quick obstetric problems after a child's life, to a decrease in glomerular filtration rate, to a decrease in water reabsorption and sodium from the primary canal in the proximal However, until recently it was shown that thiazide diuretics can increase the number of aquoporin-2 molecules on the membranes of the epithelial cells of the nephron channels, just like vasopresin. At the same time, there is no reason to waste a lot of time to improve your life, or the signs of high blood pressure.
When endomethacin is detected, additional velmi are developed with a friendly effect, however, the refinery can provoke development of two-fingered intestinesі shlunkovo-intestinal bleeding.

Non-drug treatment:
With the central ND z normal function to the center of sprague - a great nutritional regime, the day is very special. If there is a deterioration in the function to the center of the sprague: In case of nephrogenic ND - intercourse salts, implantation of products, rich calories.

Drug treatment:
Minirin, tablets of 100, 200 mcg
Minirin, oral lyophilisate 60, 120, 240 mcg
Preynex, nasal spray, 10mcg / dose
Triampur-compositum 25 / 12.5 mg tablets
Indomethacin - tablets, in a intestinal corrosive shell of 25 mg

Інші vidi lіkuvannya: -

Hirurgicne involvement: When newly approved hypothalamic-hypophyseal region.

Prophylactic come in: do not see

Further information: outpatient care

Indicators of the effectiveness of treatment and safety of methods of diagnosis and treatment, described in the protocol: Change in sprague and polyuria.

1. List of victorious literature: 1. Methodical recommendations ed ed. Didova I.I., Melnichenko G.A. "Central non-uterine diabetes: differential diagnosis and treatment", Moscow, 2010 36 pp. 2. Melnichenko GA, V.S. Pronin, Romantsova T.I. that in. - "Clinic and diagnostics of hypothalamic-hypophyseal illnesses", Moscow, 2005r., 104 side. 3. Endocrinology: national curriculum, ed. Didova І.І., Melnichenko GA, Moscow, GEOTAR-Media, 2008, 1072 p. 4. Pigarova EA - Non-fertile diabetics: epidemiology, clinical symptoms, go to lykuvannya, - "Doctor.ru", No. 6, part II, 2009r. 5. Practical endocrinology / ed. Melnichenko G.A.-Moscow, "Practical Medicine", 2009r., 352 p. 6. Neuroendocrinology / Genri M. Cronenberg, ShlomoMelmed, Kenneth S. Polonsky, P. Rid Larsen, translated from English. Pid ed. Didova І.І., Melnichenko G.A., Moscow, "RidElsіver", 2010, 472 p.

information

List of publications:
1. Danyarova LB - Candidate of Medical Sciences, a specialist in endocrinology of NDI cardiology and internal ailments, a doctor-endocrinologist of the highest category.
2. Shiman J.J. - a young scientist in science in the field of endocrinology NDI cardiology and internal ailments, doctor-endocrinologist.

Ordering for the presence of a conflict of interest:Відсутнє.

reviewer: Erdesova K.Є. - Candidate of Medical Sciences, Professor, Department of Internship KazNMU.

Letting the minds look at the protocol: The revision of the protocol is not carried out earlier, at least 1 time in 5 years, or if new data are appropriate for the diagnosis and treatment of inconvenient illness, I will become a syndrome.

Attached files

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Diabetes insipidus (non-uterine diabetes) is a rare endocrine ailment, as it appears through the deterioration of the functions of the hypophysis, hypothalamus or nirok. For an affliction, polydipsia is characteristic (the appearance of post-sprague) and polyuria (the advance of the approval of the battle is from 6 to 50 years for dobu).

It’s a chronic illness, but it can develop in women and in choloviks in any occasion, but most often, the syndrome of non-bloody diabetes occurs in people from 18 to 28 years of age.

Hypophysis and hypothalamus є by internal secretions, which are interconnected. The stench is like a control panel, core endocrine vines to the body.

Brutal respect! Sector neurons of the hypothalamus circulate hormones - oxytocin and vasopresin.

Antiduretic hormone - vasopressin to get into the back of the hypophysis. The hormone is seen in the time of consumption and control of the amount of moisture in the nephrons of nirok.

If there is a decrease in the concentration in the blood of the anti-diuretic hormone in the nirkas during the process of vigorous soaking of water, it will get tired, through which polyuria will form.

Symptoms and causes of non-bloody diabetes

Syndrome of non-congenital diabetes mellitus appears, even in the body pathological changes, Reasons for being shrieked in:

• vasopresin to the strength of the rozpadі;
• confirmation of the diagnosis in hypophysis and hypothalamus;
• among the clitin-targets in the nirkah, there is a change in sensitivity to antidiuretic hormone;
• vices of the hypothalamus abo the hypophysis;
• decongestant factor (autosomal dominant type);
• poorly trained heads or a short-term neurosurgical prompt engagement, Through scho vidbuvaєtsya the delivery of neurons to vasopresin;
• oncological metastases that cause negative inflow on the robot both zaloz;
• autoimmune i Infectious diseases, Schedule neurons of antidiuretic hormone.

Head symptoms of urinary excretion - polydipsia and polyuria, s step by step bend.

Symptoms that appear with a trivial overload of ailments

For trivially overwhelming ailment, there are characteristic symptoms such as an increase in the slash, drooping and elongation of the slunk. Also, with the syndrome of unhealthy diabetes, symptoms such as anorexia (overweight), bloating and nausea are found.

offensive characteristic symptoms- reduction of arterial grip, apathetic stance and asthenia. Likewise, a non-bloody diabetes sufferers have symptoms such as headaches and headaches.

Also, the symptoms of non-bloody urination are scared in the throat:

1. dry і atonic shkіra;
2. may be judged;
3. fell into the willows.

Also, when there is a sharp change in the position of the patient, the patient develops symptoms such as orthostatic collapse.

diagnostics

When diagnosing a diagnosis, it is important to correctly set the shape of the ailment, so that it is optimal. For the diagnosis of illness, an important anamnesis and symptoms, which are indicative of polydipsis and polyuria (more than two years for a dose).

Also, there are clinical and anamnestic data to testify about the syndrome of non-bloody diabetes, which is a sign of analysis. With a lot of people, it is necessary for an hour to see from the driver.

Also, the patient of the building for the analysis I cut and shelter, for the benefit of:

• the strength of the section;
• osmolarity;
• concentration of nitrogen, calories, glucose, sodium, calcium in the blood;
• glucosuria.

Analysis for dry eating is also carried out, with any patient not implanting water from 8 to 24 years. In the process of testing the skin, it’s time to fix the vagina, the breadth of the urine, and vymeryutsya together with the sodium in the battle.

As soon as the patient's vagina will decrease by 5%, and the amount of sodium will be more than 3 mmol / l, until the end of the day. So, it is possible to confirm the appearance of an unhealthy diabetes, at any time of the day, an antidiuretic hormone, so that it is possible to carry out a differential diagnosis of the nervous and mental.

Differentiation of nephrogenic and hypothalamic syndrome of non-congenital diabetes can be done on the basis of a pre-test for Minirin: a test for Zimnitskiy before taking Minirin and receiving an implantation of the drug. As soon as the received urine obsyag to speed up, and the desire to move, then the diagnosis is made - hypothalamic non-fertile diabetes.

For the differentiation of the nephrogenic and hypothalamic type, the change in vasopressin in the blood is even more important: with nephrogenic diabetes, the amount of the hormone of alleviation, and in the other, it is underestimated.

For diagnostics of central type diabetes mellitus, MRI is susceptible to manifestation of pathologies, diseases and education in hypophysis.

lykuvannya

Non-blood diabetes of the central type

Likuvannya tsy kind of non-bloody diabetes is possible on the basis of respect for post-mortem therapy. The main drug, for the help of which there is a success in treatment, is Desmopressin and its type:

• Minirin (tablets) - a piece analogue of antidiuretic hormone;
• Adiuretin (ampoules) - for intranasal administration.

Minirin (piece vasopressin)

When taken, the drug can be found in the blood after 15-30 quills, and its concentration can be reached through 120 quills.

Dose the drug individually, follow the results of the drug intake, if the drug is at the cob stage. The dose will rise, fallen asleep in the vipitos of the origin and the number of sechovipuscan. As a rule, the warehouse won 1-2 tablets per day.

We will take it for six years to come, or for two years to come. Hour for Minirin is from 8 to 12 years old, then take three times to do it.

In case of an overdose, you can show up:

• swelling;
• head b_l;
• Decrease in dyuresis.

The reasons for overdosing are often associated with nevirnoy dosuvannya, wrinkle climate, sinewy and wicked way of living.

Treatment of non-bloody diabetes of the nephrogenic type

Likuvannya tsya type of ailment can be based on the value of summedy therapy, so it is built up from the older types of diuretics with the smallest implants of salt. The price is necessary for the improvement of the effectiveness of the thiazidnyhdiuretics.

Also, in addition to lіkuvannya іngіbіtorі prostaglandins: ibuprofen, aspirin, indomethacin.

Brutal respect! Desmopressin is not effective in case of nephrogenic type of diabetes mellitus.

Likuvannya dipsogenic type of illness does not require medications. Yogo head meta - a change in the number of living years.

Harchuvannya in case of uncouth diabetes

With the syndrome of unhealthy diabetes, the sick should be surrounded by a small amount of salted salts, alcohol and alcohol. The head warehouse is responsible for buty milk products, fruits and vegetables.

And for a change of sprague, go cold and drink with apple and lemon.

Non-fertile diabetics suffer from a lack of vasopressin, which is controlled by the reabsorption of water in the distal tubules of the nirkovy nephron, and in physiological minds there is a negative concept of "free" water on a scale that is necessary for

There is a number of ethological classifications of non-diabetic diabetics. Often, for those who are vicious, they have grown to a central (neurogenic, hypothalamic) non-fertile diabetes with a lack of vasopressin production (more or less often) and peripheral. To the central forms, there are true, symptomatic and idiopathic (family or abnormalities) non-congenital diabetes. With peripheral non-vascular diabetes, there is a normal production of vasopressin, a lesser degree of sensitivity to the hormone receptors in the nerve tubules (nephrogenic vasopressin-resistant non-vasopressive diabetes) and a lower sensitivity to hormone receptors

The reason for the central forms of non-bloody diabetes can be ignited, degenerative, traumatic, puffy and so on. The reduction of the growth of hypophysis of the hypothalamic-neurohypophysis system (the anterior nucleus of the hypothalamus, the supraoptic hypophyseal tract, the posterior part of the hypophysis). The specific reasons for the fallout are even more rational. True non-uterine diabetes is overtaken by a number of hospitals and chronic infections, diseases: influenza, meningoencephalitis (diencephalitis), angina, scarlet fever, whooping cough, all types of typhoid fever, septic fever, maternal tuberculosis Influenza with a neurotropic inflow occurs more often for those infections. In the world of lowering the illicit disease on tuberculosis, syphilis and other chronic infections, the causal role in the diagnosis of non-bloody diabetes has significantly changed. Affection can be caused by craniocerebral (vipadkovo and surgical), mental traumas, reduced by an electric strum, hypothermia, after an hour of vaginosity, unbarred writing of flat beds, abortion.

Childbirth may be the cause of non-bloody diabetes in children. Symptomatic non-congenital diabetes is characterized by primary and metastatic swelling of the hypothalamus and hypophysis, adenoma, teratoma, gloma and especially often craniopharyngoma, sarcoidosis. Metastasis in hypochondria, often breast cancer and thyroid glands, Bronkhiv. There are also a number of hemoblastoses - leukemia, erythromyloses, lymphogranulomatosis, in case of certain pathological elements of the blood of the hypothalamus, or the hypochondriasis of the circulatory diabetes mellitus. Non-fertile diabetes mellitus for generalization of xanthomatosis (hand-Schüller-Krishchen ailment) and may be one of the symptoms endocrine disease for congenital syndromes with impaired hypothalamic-hypophyseal functions: Simmonds, Sheen and Lawrence-Moon-Bidl syndromes, hypophysis nanism, acromegaly, hyganism, adiposogenetic dystrophy.

At the same time, the significant number of ailments (in 60-70%) the etiology of the affliction is left unattended - idiopathic non-congenital diabetes... Among the idiopathic forms of traces of genetics, declines, which sometimes occur in three, five and seven advancing generations. The type of sedation is either autosomal dominant or recessive.

The recognition of a plump and non-blooming diabetes can also develop more often than the middle of the family forms. In this hour, let’s assume that in some of the ailments with idiopathic non-congenital diabetes, the autoimmune nature of the disease from the lesions of the nuclei of the hypothalamus is similar to the destruction of the endocrine organs in autoimmune syndromes. Nephrogenic netsukrovy dіabet chastіshe sposterіgaєtsya in dіtey i obumovleny abo anatomіchnoї nepovnotsіnnіstyu nirkovogo nephron (vrodzhenі kalіtstva, kіstozno-degenerativnі that іnfektsіyno-distrofіchnі Process): amіloїdoz, sarkoїdoz, otruєnnya metoksіflyuranom, lіtієm, abo funktsіonalnim enzymatic defect: torn down produktsії cAMP klіtinah nirkovih kanaltsіv abo a decrease in sensitivity to the same effect.

Hypothalamic-hypophyseal form of non-bloody diabetes Due to the lack of secretion of vasopressin, it can be tied to lesions of any type of hypothalamic-neurohypophysis system. The parity of the neurosecretory of the nuclei of the hypothalamus and the fact that for the clinical manifestation at least 80% of the cells, which secret vasopressin, are not provided, are not affected by the great power of internal compensation. The most common diagnosis of non-uterine diabetes - in case of lesions in the area of ​​the funnel of the hypophysis, the neurosecretory paths are deduced to go through the nuclei of the hypothalamus.

Lack of vasopressin decreases reabsorption of ridin in distal view nirkova nephron and a vision of a great amount of hypoosmolar unconcentrated section. Primarily, polyuria is more likely to lead to dehydration due to the second internal and internal vascular lineage with hyperosmolarity (food 290 mosm / kg) with plasma and sprag, which can lead to water damage. At the end of the day, it was established that vasopressin wiklikak is not only antidiuresis, ale and natriyuresis. If the hormone is deficient, especially during the period of heat, if sodium is also stimulated to absorb the effect of aldosterone, the sodium will be absorbed into the body, becoming hypertonic and hypertonic.

Enzymatic activation of vasopressin in the liver, nirkah, placenta (before the hour of vaginosity) is enhanced, due to the lack of hormone. Non-bloody diabetes with vaginosity (transient or even more stable) can also be applied to lower osmolarity of the spraga threshold, so that the energy of water is increased, and plasma is reduced and the pressure reduced. The reason for the increased frequency of over-the-top diabetes and the growing need for medicinal drugs. It seems that the refractoriness of nirok to endogenous and exogenous to vasopressin is also caused by a lack of hormone in the body.

pathogenesis

Іstinny netsukrovy dіabet rozvivaєtsya vnaslіdok poshkodzhennya gіpotalamusa i / abo neurohypophysis at tsomu destruktsії whether yakіy chastinі neyrosekretornoї system utvorenoї supraoptіcheskіe i paraventricular nuclei gіpotalamusa fibrous tract nіzhki i zadnoї chastok gіpofіza, suprovodzhuє atrofіya іnshih її Chastain and takozh poshkodzhennya funnel. In the nuclei of the hypothalamus, the leading rank in the supraoptic, there is a decrease in the number of large neurons and important gliosis. Primary swellings of the neurosecretory system accumulate up to 29% of cases of non-congenital diabetes, syphilis - up to 6%, and skull injuries and metastases in the development of the neurosecretory system - up to 2-4%. The chicks of the anterior lobe of the hypophysis, especially large, take the winnings at the crows and the back of the hypochondrium, which in their turn can lead to the development of a non-blooming diabetic. The reason for the rapid engagement in the suprasellar area is the reduction of the hypophysis and the onset of the atrophy and the development of the great nerve cells in the supraoptic and / or paraventricular nuclei and atrophic posterior lobes. Tsi appearances in the ranks of werewolves. Pislyapologic discoloration of the adenohypophysis (Sheen's syndrome) through thrombosis and hemorrhage in the lower hypophysis and interruption of the neurosecretory pathway can also lead to non-diabetic diabetes.

Among the decaying variants of non-congenital diabetes є fall in the reduction of nerve cells in the supraoptic and in the paraventricular nuclei. Analogous vintages are promoted in the same types of illnesses. Defects in the synthesis of vasopresin in the paraventricular nucleus are rare.

Nabutyne nephrogenic non-congenital diabetes can develop with nephrosclerosis, polycystosis, or congenital hydronephrosis. At the same time, in the hypothalamus, the hypertrophy of the nuclei and all types of the hypophysis is indicated, and in the cortex of the supra-nircular halluses - the hyperplasia of the glomerular zone. In case of nephrogenic vasopressinresistant non-mucous diabetics, there is little change. In some cases, the expansion of the nirk bowls is meant, or the dilatation of the small tubes. Supraoptic nuclei, either not change, or even more pertrophied. Ridkisnim accelerated incapacitation є massive internal scalp calcification of blood speech from measles to the brain from the front to the upper part.

For the last few years, idiopathic non-fertile diabetics are often associated with autoimmune disease and organ-specific antibodies to vasopressin-secreting and more oxytocin-secreting cells. In general structures of the neurosecretory system, lymphoid inflammation appears in the form lymphoid foliage and in some significant substitutions of parenchymal structures by lymphoid tissue.

Symptoms of non-bloody diabetes

An ear of malnutrition is very sensitive, raptus, before the symptoms of non-bloody diabetics appear step by step and grow in intensity. Excessive diabetes is chronic.

The severity of the disease, i.e. With an inconsistent deficiency of vasopressin, clinical symptoms may not be very vivid, and the very form of a diagnostic diagnosis. There is a bit of birth, which can be boiled in from 3 to 15 liters, but sometimes it is a lot of sprague, but not a sick day, not in the afternoon, but in the evening, it is necessary to drink for 20-40 or more years of water. Children can be quickened by this let's get to know ailments. As soon as you see a cut of zebrafish, do not take revenge on any pathological elements, for example, the width of all ports is very low - 1000-1005.

Polyuria and polydipsia of supervising physical and mental asthenizatsiya. Appetite for lowering, and consuming ailments in the mass of tila, in the case of primordial hypothalamic destructions, navpaki, obesity develops.

A shortage of vasopressin and polyuria is injected into the shlunkovaya secretion, bile formation and motility of the shlunkovo-intestinal tract and will cause constipation, chronic and hypacidic gastritis, colitis. At the junction with the permanently rewounding, the shutter does not stretch out and go down very quickly. The dryness of the skin and mucous membranes, the decrease in saliva and sweat are indicated. Women have a reduced menstrual and early function, and men have a decrease in libido and potency. Children do not grow up very quickly, physical and statical maturity.

Heart-sudinna system, legends, pechinka do not suffer. With important forms of true non-congenital diabetes (recessive, post-infectious, idiopathic) with polyuria, which reaches 40-50 and more years, as a result of overstraining, I become insensitive until they are introduced into the majority of cases. So, before the primordial-hypotha-lamic non-bloody diabetics, nephrogenic diabetics.

Characteristics of mental and emotional damage - headaches, sleeplessness, emotional neurological importance right up to psychoses, decreased pink activity. Children have gratitude, tearfulness.

In vipads, if one does not get lost in the cross section, one does not remember (a decrease in sensitivity to the center of the “spragy”, the visibility of water, a dehydration test with “dry food”), detects the symptoms of anger: weakness of the tart thickening of blood (with adjustments of sodium, erythrocytes, hemoglobin, surplus nitrogen), sudom, psychomotor energy, tachycardia, hypotonia, collapse. Symptoms of hyperosmolar dehydration are especially characteristic of congenital nephrogenic non-congenital diabetes in children. In case of nephrogenic non-bloody diabetes, the sensitivity to vasopresin is often saved.

An hour of degradation, unaffected by a change in the amount of circulating blood and a decrease in glomerular filtration, polyuria, the concentration of blood and osmolarity may not grow up 10 (as a result)

Non-blood diabet pislya surgical engagement on hypophysis or hypothalamus can be transient or permanent. With severe injuries, the disease is not transmitted, so as spontaneous weariness is spontaneous through a few (up to 10) years of injury.

Non-blooded diabetics among the ailments of the ailments will mingle with the blooded ones. It will explain the localization of the hypothalamic centers, how to regulate the water and carbohydrates, and the structural and functional closeness of the neurons of the hypothalamic nuclei, which produce vasopressin and in the form of vasopressin.

Diagnosis of non-congenital diabetes

In typical types, the diagnosis is not difficult and it is not difficult to ground on the detected polyuria, polydipsia, plasma hyperosmolarity (more than 290 mosm / kg), hypernatrium (more than 155 meq / l), 100-200 kg One hour the value of the osmolarity of the plasmas and the second gives the necessary information about the impairment of the water homeostasis. To determine the nature of the disease, it is possible to analyze the anamnesis and the results of radiological, ophthalmological and neurological conditions. If necessary, swallow up to computer tomography... The most important value in diagnostics could be the value of the basal and stimulated level of vasopressin in plasma, however, the process of prior clinical practice is inaccessible.

Differential diagnosis

Non-fertile diabetics differentiate with a number of ailments, which oppose polyuria and polydipsia: diabetics, psychogenic polydipsia, compensatory polyuria in the azotemic stage of chronic glomerulonephritis.

Nephrogenic vasopressinresistant non-congenital diabetes (congenital and nabutia) differentiates from polyuria, which is associated with primary aldosteronism, hyperparathyroidism with nephrocalcinosis, syndrome of damaged adsorption.

Psychogenic polydipsia is idiopathic or, in conjunction with mental illness, is characterized by primordial spragoy. Vona is surrounded by functional or organic damage in the center of sprague, which leads to an uncontrolled reception of a great age. Reducing the amount of circulating birth reduces the osmotic grip and, through the system of osmoregulating receptors, reduces the level of vasopressin. So (suddenly) there is a polyuria with a low tolerable slaughter. Plasma osmolality and sodium level in both normal and low levels. Obmezhennya priya i rіdini degіdratatsіya, stimulyuyucha endogenny vazopresin from ailments of psychogenic polіdipsіya on vіdmіnu od s ailing netsukrovy dіabet not porushuyut zagalnogo camp, Quantity sechі scho vidіlyaєtsya vіdpovіdno zmenshuєtsya and її osmolyarnіst i vіdnosna schіlnіst normalіzuyutsya. However, in case of trivial polyuria of nirka, the response rate to vasopressin is gradually reduced to the maximum increase in osmolarity of the section (up to 900-1200 mosm / kg), and in the case of primary polydipsia, the normalization of the normalization of vasopressin is possible. For those who are ill for unhealthy diabetes, with a change in the number of children in their birth, the zagalny camp will burn out, spranga becomes large, it grows with anger, and some of the section is growing, but it is not enough to see a lot of osmolyarity. At the connection with the cym, the dehydration differential diagnostic test for dry food should be carried out in the minds of the stationary, and the triviality is not to blame for 6-8 hours. The maximum test rate with good tolerance is 14 hours. It is very good and important to see it in the skin of the year old, and the mass is in the skin of the skin of the day. The visibility of the dynamics of endogenous production in two advances at the expense of 2% weight indicates the visibility of the stimulation of endogenous vasopresin.

With the help of differential diagnostics from psychogenic polydipsia inodis vikoristovuyu test with internal injections of 2.5% sodium chloride (50 ml injected with a stretch of 45 minutes). In ailments with psychogenic polydipsia, the osmotic concentration in the plasma rapidly stimulates the endogenous vasopressin, a number of visions change, and the generality of the disease grows. In case of unsuccessful diabetics, obsyag and concentration of the slaughter does not change. It means that it is even more important for children to transfer the sample from the salt mixtures.

Administration of drugs in vasopressin in case of true non-uterine diabetes mellitus, polyuria and apparently polydipsia; in case of psychogenic polydipsis in conjunction with the introduction of vasopressin, headaches and symptoms of water intoxication can occur. In case of nephrogenic non-circulating diabetes, the administration of the drug in vasopressin is ineffective. In the present day, with a diagnostic test, vikoristovoyt is overloaded with a synthetic analogue of vasopresin injected into factor VIII of the throat of blood. In people with illnesses with preoccupied forms of nephrogenic non-bloody diabetes and in the family with a rhizik, the effect of suppression of the day is affected.

With a reddish diabetic, the polyuria is not too great, as if it is not colorful, and the slaughter is hypertonic. In the blood - hyperglycemia. With the admission of a small and non-blooming diabetes, glucose concentration is increased by the concentration of blood, but with a great opportunity in the new state of affairs, the level of proficiency is reduced (1012-1020).

In case of compensatory azotemic polyuria, duresis does not peremy 3-4 liters. Hypoisostenuria is promoted with the number of patients with a high incidence 1005-1012. In the blood, there is a level of creatine, section and surplus nitrogen, in section - erythrocytes, blood cells, cylindri. A number of ailments with dystrophic symptoms in nirkas and vasopressin-resistant polyuria and polydipsia (primary aldosteronism, hyperparathyroidism, syndrome of impaired adsorption in the intestine, nephronophthiasis of Fanconia, tubulopathy)

Diabetes is called a country, when there is an increase in the number of visions by the body of a child and a compensatory spraga. Often these symptoms of diabetes mellitus are associated with glucose levels in the blood. However, in the medical diagnosis of "non-congenital diabetes", when the infusion of blood is not associated with the concentration of glucose.

Reasons for diagnosis and mechanism of development of pathology

Aggressiveness is chronic and often diagnosed in patients of 18-25 years of age. At the same time, there are drops, if the diagnosis is made of deliveries for thirty years, as well as for children of the first fate of life.

One of the symptoms of unhealthy diabetes in women - Sprague

There are two main mechanisms for the development of pathology - central and nephrogenic. The offense is tied to the vision of the hormone vasopressin and is sensitive to the new.

Clitini of the hypothalamus regulate the viroblation of vasopresin, an antiduretic hormone. Vasopressin spraying saves birth in the body and reabsorption of nirok, which can be reduced to a decrease in the number of slaughter. If there is a lack of vasopressin, the amount of moisture in the body changes, and through the polyuria it becomes more and more frequent.

The main problem is the lack of vasopressin, as there can be two reasons:

1. Neurohormonal diseases, which lead to a lack of hormone approval through damage to the central nervous system.
2. A decrease in the sensitivity of nyrc receptors to vasopresin, which often occurs through genetic damage.

Diabetes is of central genesis, with a lack of vasopressin, it can be vicious:

1. Ushkozhennymi gipofiza or hypothalamus, which produce to the destruction of the transport of the hormone or any lack of accumulation.
2. Injuries, ignited or infiltrative illnesses.
3. It is also diagnosed with idiopathic diabetes, for which the problem is overwhelmed by a genetic defect or incorrect immunological reactions.

Nircovy type of diabetes can also develop through a genetic defect, as well as due to additional pathological conditions - hypercalcifications, hypocalcifications, and injuries.

In such a rank, it is possible to see the first and second non-cerebral diabetics, as if they were present at the time of the people, or having appeared with an extension of life as the inheritance of illnesses and injuries.

Okremo vid_lyayut also non-bloody diabetics - a time-based pathology, as it is known to be on the floor. The reason for the whole drop is in the formation of vasopressin with placental hormones, which leads to a lack of antidiuretic hormone. The variability of symptoms is more likely to develop in the third trimester.

Lіkuvannya guilty passes under the control of a lіkar

Classification and classic painting

Non-fertile diabetics go on a number of types after the level of compensation and gravity:

• easy - a bit of slash, so you don't see it, 8 liters;
• middle - the patient spends up to 14 liters for dobu;
• important - without drug therapy to see more than 14 years old.

1. Compensation stage - sprague and part of going to the toilet is especially not turbulent.
2. Subcompensation - the patient is innocent to sprout and to pay for polyuria.
3. Decompensation - Sprague rolls and polyuria.

The symptomatology for diabetes is standard. Wine includes:

• skargi for strong sprague;
• a lot of water to drink by the patient up to 20 liters;
• decrease in potovіlennya;
• quickening і ryasne sechovipuskannya, go to the toilet at night;
• traces of great birth: dryness of the skin and slimy, weakness, headache, blues, sudom, thickened blood;
• expansion of the shlunk, reduction of the secretory function of the organs of the shlunkovo-intestinal tract.

Diabetes of the central genesis of the transmission of additional manifestations, tying to the damage of the robot, the hypothalamic-hypophyseal system (endocrine damage from the side of the other systems of organs).

Diagnostics and treatment

The head of the diagnostics is to find out the localization of the cause of the problem. As a matter of fact, there is a further tactic of therapy. In the diagnosis of viciousness, there is an advance of the following:

1. Test for intercourse rіdini. It is carried out in the clinic for the diagnosis of differential diagnosis of diabetics. The patient will take it dry and feel good for the skin 30 gilin. Doslidzhuєtsya rivn vasopressin and osmolarity of the sech.
2. Biochemistry and classroom analysis - an analysis showing a decrease in power below 1.005.
3. Diagnostics of the central type of non-congenital diabetes is carried out after additional MRI.

Tactics of therapy to find the cause of the diagnosis of unhealthy diabetes

Surgery for non-bloody diabetes is not carried out. Since psychogenic problems are the cause of the damage, the patient needs the consultation of a psychotherapist. In іnshikh vypadki the drug should be carried out with medication.

The main scheme of therapy for diabetes of central genesis є is replaced by therapy with an analogue of vasopresin - desmopresin. The dose is taken individually for the skin patient by a practical way. The bioavailability of new drugs based on desmopressin can be recognized, so it is necessary to respectfully know about the instructions and readily read them before the ear of treatment. CLINIC RECOMMENDATIONS lykarya.

Before the hour of therapy, the nutritional regimen is guilty - when spraga appears, it is obovyazkovo.

Ridin is especially not to be surrounded, so as it is prisvede to vnevodnenya, however, sending a cob of spraga torture the patient rіdshe.

Therapy of nephrogenic etiology for diabetes mellitus cannot be carried out with a different therapy, since the sensitivity of the receptors is too low. In general, there will be solutions to the use of anti-pyretic drugs, for example, thiazide diuretics.

The assessment of the quality of the test is carried out 1 time at a time or more often. At the same time assess:

• sprague frequency;
• the results of the analysis of the section;
• durez;
• concentration of glucose, sodium, calories, creatine in blood;
• frequency of n_chnyh sechovipuskan.

No prophylactic visits for the prevention of non-bloody diabetics have been made. Pathology to appear unsupported and in a serious approach to treatment.

In case of unsuccessful diabetics, as a result of injuries or surgery, the patient has a good chance of remission.

The remission is often infused after 3-6 months after the start, and it is possible to allow for a decrease in the dose, for example, in addition to the hormonal intake.

The treatment of non-bloody diabetes in vaginal women can also be carried out with desmopresin. Therapy for non-bloody diabetes folk zasob not very effective.

Forecast and nebezpeka zhvoryuvannya

Non-fertile diabetics and symptoms in women and men can lead to destruction of the robotic systems of organs, and also can significantly reduce the quality of life. At the time of the central genesis of non-bloody diabetes, there is a significant etiology of the problem. The health of the hypothalamus in pukhlinoyu makes an unpleasant prognosis through malignant approval, and not through diabetes.

Anyone who has a problem is not safe to lose a lot of money. Electricity consumption and consumption can lead to a lethal result, especially in young children and toddlers.

When the riziki is lowered, as the patient will remember to spend the way, he will be obliged to pay off the life of the water.

Carrying out a different therapy allows for a significant improvement in the quality of life of patients and minimization of problems in cases of ill health. at correct loveі regular monitoring of the sick prognosis of non-bloody diabetics.

If there is adequate therapy for non-congenital diabetes, it can be brought to:

• poorushen from the side of the zoru;
• neuroses, problems with sleep, sickness in robots nervous system, As soon as possible to improve the development of pathology;
• adjustments to the growth and development of children;
• expansion of nirk bowls, expansion of chafing mikhura;
• overstretching of the slunk;
• discines of young people;
• teasing of the intestines, constipation;
• dermatological problems;
• problems with the heart and the vessels through the lack of birth in the body.

Nezavisimye inheritance can also be blamed as a result of hypernatremia, if the element is lost in the blood, and some of the water changes, causing the concentration of sodium. By the manifestation of this, I will begin to p_dvishchena nerve-m'yazov zvudliv_st, ruined svidomost_, sudom.

Non-blood diabet maє chronic overrun and obstruct the organisms. With the correct likeness of the life of the patient, it will be seen. Pathology of a disease through genetic damage or a pathology of accelerated injury and illness.