Your daughter has a symptom called polydipsia, in which there is extreme thirst with consumption of large amounts of water. This symptom is seen in three main conditions- pituitary diabetes insipidus, nephrogenic diabetes insipidus and compulsive water drinking.

A.

Pituitary diabetes insipidus results from insufficient production of antidiuretic hormone (ADH) which functions in the kidney to promote the reabsorption of water. When ADH levels are too low, the water that passes through the kidneys is excreted instead of being reabsorbed. This can result in the production of up to 18 liters of urine per day, thus the extreme thirst and need for fluid replacement in the body. Pituitary diabetes insipidus is caused by disruption of the secretion of ADH from the posterior pituitary gland. This can be from a malfunctioning hypothalamus (which produces ADH) or from problems like head injury, pituitary tumors, cerebral blood vessel problems or infections of the brain that damage the hypothalamus or posterior pituitary gland. If the person with pituitary diabetes insipidus is deprived of water intake, they can quickly have circulatory collapse or hypertonic encephalopathy- both very serious emergency situations. Treatment for pituitary diabetes insipidus is replacem ent of ADH and/or the use of specific prescription diuretics.

Nephrogenic diabetes insipidus results when there is a reduced response of the kidneys to ADH. This most commonly occurs when the kidneys are damaged by disease. Kidney infection, chronic kidney diseases, sickle cell anemia, medications or toxins, excess blood calcium and too little blood potassium are all associated with nephrogenic diabetes insipidus. Diabetes mellitus ('sugar diabetes') can also cause nephrogenic diabetes insipidus, either through kidney damage or by the excess glucose that is excreted in the urine. Excessive thirst and water consumption- polydipsia and excess urine production- polyuria, are also the primary symptoms in nephrogenic diabetes insipidus, but the amount of urine produced is much less than in pituitary diabetes insipidus. Treatment is directed at correcting the underlying condition, the use of selected prescription medications and maintenance of fluid and electrolyte balance. Inadequate fluid intake or excessive fluid loss can further reduce kidney function and ca use electrolyte imbalances.

Compulsive water drinking or psychogenic polydipsia is due to a psychological illness. Unlike pituitary and nephrogenic diabetes insipidus in which the extreme thirst and excessive urination are present at night, compulsive water drinkers are not usually awakened by thirst or the need to urinate. Prolonged psycholgenic polydipsia can disrupt the normal kidney response to ADH as well as temporarily decreasing the release of ADH, and it may take several weeks for the kidneys to return to normal with restriction of fluid intake. Treatment is directed to the underlying psychological illness.

Since all of three of these conditions can result in serious complications and may have serious underlying disease present, I would recommend that you have your daughter evaluated by a pediatric specialist or specialists right away. For proper diagnosis, an endocrinologist, a kidney specialist, a neurologist and/or a psychiatrist may be needed. Your daughter's pediatrician is a good place to start.

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