Diabetes insipidus is a disorder that causes fluid imbalances in the body, which can lead the patient to have polyuria, large amounts of urine, and polydipsia, which makes them feel very thirsty despite drinking fluids.
A healthy adult usually produces about 1 to 2 liters of urine a day. However, an adult who has severe diabetes insipidus may produce up to 20 liters of urine in 24 hours or may pass urine more than 7 times in a day.
Because of its distinctive signs and symptoms, strict input and output monitoring and accurate fluid management are both required for patients with this uncommon disorder. Diabetes insipidus is believed to be caused by a hormone imbalance of the antidiuretic hormone (ADH), also known as vasopressin or AVP.
Diabetes insipidus is not related to diabetes mellitus, as it does not involve a disturbance in the blood glucose levels compared to the latter.
Signs and Symptoms of Diabetes Insipidus
The following are the signs and symptoms of diabetes insipidus:
- Polydipsia – feeling of extreme thirst despite drinking the usual amounts of fluids
- Polyuria – passing urine in large amounts and usually pale in color
- Nocturia – increased urinary frequency at night
- Preference for cold drinks
In infants or young children, the following signs and symptoms of diabetes insipidus may be observed:
- Bed-wetting
- Heavy, wet diapers
- Trouble sleeping
- Weight loss
- Delayed growth
- Constipation
- Vomiting
Causes of Diabetes Insipidus
The fluid part of the blood called plasma is filtered by the kidneys to take away the waste products. After the filtering process, the hormone vasopressin or anti-diuretic hormone (ADH) helps the filtered plasma to return to the bloodstream.
ADH is produced in the hypothalamus and is stored in a small gland called the pituitary gland of the brain. Any deficiency of ADH or blockage of its effect causes an increase in the production of excess urine. Problems with ADH levels can cause imbalances in the fluid levels of the body.
Types of Diabetes Insipidus
There are two main types of diabetes insipidus: central and nephrogenic. The other two rare types include gestational diabetes insipidus and dipsogenic or primary polydipsia. In some cases, the cause could be an autoimmune response that results in unwanted damage to the vasopressin-making cells.
- Central diabetes insipidus. The normal process of producing, storing, and releasing ADH can be affected by any damage to the hypothalamus or the pituitary gland. Conditions such as brain tumors or malignancy, brain infections, head injuries, or even surgery can cause this type of diabetes insipidus. Rarely, the disease can also result from a genetic disorder inherited from the person’s parents.
- Nephrogenic diabetes insipidus. This type of diabetes insipidus is caused by any defect in the parts of the kidneys. When the kidney structures are damaged, the organ will not be able to respond appropriately to ADH. This will result in polyuria and nocturia. The damage can be caused by a chronic or long-term kidney disorder, a genetic disease, and/or the use of certain medications such as some antivirals and the drug lithium.
- Gestational diabetes insipidus. A rare disorder during pregnancy, gestational diabetes insipidus happens when ADH is destroyed by a placenta-produced enzyme.
- Dipsogenic diabetes insipidus. Also called primary polydipsia, this type of diabetes insipidus involves damage to the mechanism that regulates thirst in the hypothalamus. Recent studies relate it to some mental health disorders, such as schizophrenia. It causes the patient to drink very large amounts of fluids and pass huge amounts of diluted, pale urine.
Risk Factors for Diabetes Insipidus
The following are risk factors for the development of diabetes insipidus:
- Genetics. The disease can be hereditary and can develop at birth or shortly after being born. There could be permanent changes in the structures of the kidneys, disabling the baby to concentrate urine.
- Sex. Males are usually affected by nephrogenic diabetes insipidus. However, women may pass the gene to their kids.
Complications of Diabetes Insipidus
- Dehydration. Diabetes insipidus may result in dehydration if left untreated. A dehydrated patient may have increased fatigue, thirst, dryness of the mouth, and poor skin elasticity or skin turgor.
- Electrolyte imbalance. Diabetes insipidus can affect the balance of the electrolytes, particularly serum sodium and potassium, which are the two main electrolytes involved in fluid balance. An imbalance of these electrolytes can result in muscular weakness and cramps, acute confusion, loss of appetite, nausea, and/or vomiting.
Diagnosis of Diabetes Insipidus
- Water deprivation test. In this exam, the patient will be subjected to oral fluid cessation for a few hours. The nurse should measure the changes in the urine output, body weight, and concentration of blood and urine while the body is deprived of water and other fluids. The test aims to check if the body’s production of ADH is adequate and to assess the response of the kidneys to ADH. The physician may order the administration of synthetic ADH during the water deprivation test.
- Magnetic resonance imaging (MRI). To check for any abnormalities in the pituitary gland, an MRI of the head may be ordered. An MRI can help see detailed images of the brain tissues in and around the pituitary gland through the non-invasive method of using radio waves in a magnetic field.
- Genetic testing. The doctor may order a genetic screening procedure if the patient’s family members also suffer from excessive urine production or polyuria.
Treatment for Diabetes Insipidus
The type of diabetes insipidus determines the treatment required, which may include the following:
- Central diabetes insipidus. The physician may prescribe a synthetic replacement for ADH called desmopressin, which can help reduce urination. It is usually available in tablet form, but can also be given by injection or as a nasal spray. The drug may result in unwanted water retention and hyponatremia or low sodium levels if taken too much, so the amount of desmopressin may vary depending on the ADH level in the body. Another type of medication is one that can help increase the availability of ADH in the body.
- Nephrogenic diabetes insipidus. This type of D.I. is usually treated with a low-sodium diet to facilitate the reduction of urine that is produced by the kidneys. The doctor may prescribe a diuretic called hydrochlorothiazide to improve polyuria. The patient will also be encouraged to drink adequate amounts of water daily. Desmopressin will not be helpful in this type of D.I.
- Gestational diabetes insipidus. Synthetic hormone desmopressin is usually the treatment of choice in pregnant women with D.I.
- Dipsogenic diabetes insipidus. The physician will instruct the patient to decrease oral fluid intake. As this type of D.I. can be strongly related to an underlying mental health condition, treating the specific mental health disorder may have a positive effect on primary polydipsia.
- Lifestyle changes. The patient will be instructed to take measures to prevent dehydration and electrolyte imbalance, which are the two most common complications of diabetes insipidus. The patient should carry water wherever they go and must never stop the prescribed medication abruptly or on their own. It is also recommended to carry a medical alert card in their wallet or wear a medical alert bracelet which can help if the patient has a medical emergency.
Nursing Diagnosis for Diabetes Insipidus
Diabetes Insipidus Nursing Care Plan 1
Nursing Diagnosis: Deficient Knowledge related to lack of understanding of the condition and its treatment regimen and unfamiliarity with the complications secondary to diabetes insipidus as evidenced by asking numerous questions and verbal expression of misconceptions about the illness
Desired Outcome: The patient will verbally express their complete comprehension of diabetes insipidus and the medications used in the treatment.
| Diabetes Insipidus Nursing Interventions | Rationale |
| Determine the patient’s level of understanding about the causes and treatments of diabetes insipidus. | Personalized teaching plans are created based on the patient’s knowledge and desire for more information about diabetes insipidus. |
| Provide written information about diabetes insipidus diagnostic procedures such as computed tomography scans or magnetic resonance imaging. | If a pituitary tumor is suspected of being the cause of diabetes insipidus, the doctor may order these procedures. |
| Inform the patient about the water deprivation Antidiuretic Hormone (ADH) stimulation test. | This test can distinguish between nephrogenic and neurogenic causes of diabetes insipidus. Before collecting blood samples to measure ADH levels, the doctor will instruct the patient to consume nothing by mouth (NPO) for 12 hours. ADH levels are higher in nephrogenic DI and lower in neurogenic (central) DI. Vasopressin may be administered to assess renal response. In nephrogenic DI, there is no reaction to the drug. |
| Determine the patient’s readiness to learn. | Polyuria can cause rapid fluid loss, which can impede cognitive function. This mental state change can impair the patient’s capacity to absorb new information. |
| Educate the patient on the importance of carefully monitoring fluids and electrolytes balance, which includes the following: -weighing oneself at the same time of day with the same amount of clothing -monitoring of fluid intake and output -urine’s specific gravity measurement | This approach helps the patient monitor their illness so that modifications can be made as needed. It also aims to prevent undertreatment or overtreatment with medication. |
| Discuss with the patient when to seek additional medical attention. Instruct them to acknowledge signs of medication underdose or overdose. | Patients with chronic diseases must be able to recognize significant changes in their condition to prevent complications and hospitalization. |
Diabetes Insipidus Nursing Care Plan 2
Nursing Diagnosis: Deficient Fluid Volume related to endocrine regulatory mechanism dysfunction, hypophysectomy, impairment of the neuro-hypophyseal, and hypopituitarism secondary to diabetes insipidus as evidenced by polyuria, polydipsia, and rapid weight loss
Desired Outcome: The patient will have average fluid volume, as evidenced by the noticeable lack of thirst, a standard blood sodium level, and an unchanging weight.
| Diabetes Insipidus Nursing Interventions | Rationale |
| Keep track of the patient’s intake and output. Advise the patient to disclose to the nurse if a urine volume of more than 200 mL every 2 hours or 500 mL in 2 hours is produced. | With diabetes insipidus, the patient voids large amounts of urine regardless of fluid intake. With renal diabetes insipidus, urine output ranges from 2 to 3 L/day to more than 10 L/day with central diabetes insipidus. |
| Thoroughly observe the patient for signs of increased thirst (polydipsia). | Thirst can be a reliable indicator of fluid balance if the patient is conscious and the thirst center is intact. Polyuria and polydipsia are strong indicators of DI. Furthermore, patients with diabetes insipidus prefer ice water. |
| Remind the patient to weigh themselves every day. | Excessive fluid loss causes weight loss. |
| Keep a record of the patient’s urine-specific gravity. | A patient with diabetes insipidus may have a specific gravity of 1.005 or less. |
| Observe the patient’s blood and urine osmolality. | In patients with diabetes insipidus, urine osmolality decreases while serum osmolality increases. |
| Keep track of the patient’s urine and plasma sodium levels. | The patient with diabetes insipidus has hypernatremia and reduced urine sodium levels. |
| Check the patient’s serum potassium level. | Hypokalemia can occur as a result of an increase in urinary potassium output. |
| Monitor patients for manifestations of hypovolemic shock, such as hypotension, tachypnea, and tachycardia. | Frequent evaluation can accurately detect diabetes insipidus early, allowing for prompt intervention. Polyuria reduces circulatory blood volume. |
| Encourage the patient to drink water whenever they want. | Patients with healthy thirst mechanisms can keep their fluid balance by consuming much water to compensate for the quantity they urinate. Patients with diabetes insipidus prefer ice water or cold water. |
| Maintain an easily accessible fluid source and adequate fluids at the patient’s bedside. | This approach promotes fluid intake. |
Diabetes Insipidus Nursing Care Plan 3
Risk for Impaired Skin Integrity
Nursing Diagnosis: Risk for Impaired Skin Integrity related to urinary recurrence, large volume output, and the possibility of incontinence secondary to diabetes insipidus
Desired Outcome: The patient’s skin will be intact and remain undamaged.
| Diabetes Insipidus Nursing Interventions | Rationale |
| Examine the patient’s skin and record any changes in the condition. | Early diagnosis and treatment may help prevent the progression of impaired skin integrity. Polyuria or excess urination causes fluid loss, significantly reducing skin turgor and causing dryness. |
| Maintain clean, wrinkle-free bed linen. | This approach eliminates shearing forces. |
| As needed, apply skin barriers to the patient. | The skin barriers prevent urinary frequency-related redness or excoriation. |
| Evaluate other variables that could endanger the patient’s skin integrity, which includes lack of mobility, nutritional requirements, and mental state changes. | Excess moisture from incontinence can increase the risk of skin breakdown from other sources. |
| Provide the patient with quick access to the restroom, urinal, or bedpan. | Polyuria and polydipsia interfere with the patient’s everyday routines, including sleep. The ease of access to the restroom, urinal, or bedpan will reduce inconvenience and frustration. |
| Examine the patient’s continence or incontinence. Determine whether an indwelling urinary catheter is required. | Skin breakdown is exacerbated by excess moisture on the skin. |
Diabetes Insipidus Nursing Care Plan 4
Nursing Diagnosis: Disturbed Sleep Pattern related to an increase in urinary frequency and anxiety about the condition secondary to diabetes insipidus, as evidenced by discontentment with sleeping habits, waking up earlier or later than desired, general fatigue, and sleep disruption.
Desired Outcome: The patient will get an adequate amount of sleep, as demonstrated by a refreshed appearance, verbalization of feeling relaxed, and an improvement in sleeping habits.
| Diabetes Insipidus Nursing Interventions | Rationale |
| Instruct the patient on appropriate fluid and food intake, such as preventing big meals, liquor, caffeine, or cigarettes before bed. | Full meals just before bedtime may cause gastrointestinal upset and delay sleep onset. Caffeine-containing beverages such as coffee, tea, chocolate, and colas may cause nighttime urination. These beverages may impair the patient’s ability to relax and sleep. Alcohol causes drowsiness and may aid sleep initiation, but it disrupts REM sleep. |
| Encourage the patient to exercise during the day, but inform them to avoid vigorous activity before bedtime. | Therapeutic techniques can reduce stress and improve sleep patterns. Rigorous activities, on the other hand, can lead to burnout and sleeplessness. |
| Instruct the patient to keep a standard daily sleep and rest timetable. | Consistent schedules help regulate the circadian rhythm and reduce the energy required for adaptation to changes. |
| Remind the patient to avoid drinking many fluids before bed. | This approach aims to prevent the patient from needing to use the restroom in the middle of the night. |
| Before bedtime, incorporate relaxing activities such as a hot bath, soothing music, reading books, and mindfulness training. | These activities provide stress relief and diversionary tactics, allowing the mind and body to prepare for sleep. |
| Instruct the patient on using OTC, herbal, and prescription sleeping medications. | These medications may be helpful if the patient has short-term sleep disturbances. |
| Assist the patient in understanding the root cause of their sleeping problems. | Incorrect perceptions of sleep disturbances can cause fear and anxiety. |
Diabetes Insipidus Nursing Care Plan 5
Nursing Diagnosis: Nausea related to disparities in minerals in the blood, such as potassium and sodium (electrolytes), which preserve the body’s fluid equilibrium secondary to diabetes insipidus as evidenced by dizziness and lethargy.
Desired Outcome: The patient will report less severe or complete elimination of nausea.
| Diabetes Insipidus Nursing Interventions | Rationale |
| Determine the sources of the patient’s nausea. | Assessing the patient’s causes of nausea will determine the type of intervention. If the stimulus is removed, treatment may not be required. |
| Monitor the patient’s fluid balance, daily weights, blood pressure, intake and output, and skin turgor. | Nausea is frequently associated with vomiting, which can alter a patient’s hydration status due to fluid loss. |
| Analyze the following nausea characteristics: -history -duration -recurrence -severity -precipitating variables -medications | A comprehensive evaluation and assessment of nausea can assist in determining interventions to mitigate or alleviate the problem. |
| Make an emesis basin easily accessible to the patient. Vomiting and nausea are directly connected. | If the nausea is psychogenic, keep the emesis basin out of sight but still within reach of the patient. |
| Encourage the patient to use non-pharmacological nausea control methods like relaxation, mental imagery, music therapy, distraction, or deep breathing techniques. | These treatments have helped patients with the condition, but they must be utilized before it happens. |
| If tolerated and appropriate for the patient’s diet, consider introducing cold water, ice chips, ginger products, and room-temperature broth or bouillon. | These methods aid in hydration. Ginger relieves nausea when consumed as ginger ale, ginger tea, or crystallized ginger. Fluids that are too cold or too hot may be uncomfortable to drink. |
| Instruct the patient to prevent unnecessary foods and smells that cause nausea. | Strong and unpleasant odors can cause nausea. |
| Instruct the patient or caregiver that if vomiting emerges or continues for more than 24 hours, they should seek medical attention. | Vomiting regularly can cause dehydration, electrolyte imbalances, and nutrient deficiencies. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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