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Problem-oriented approach to Polyuria:Polydipsia

Problem-oriented approach to Polyuria:Polydipsia. Jill McClure, DVM, MS Diplomate ACVIM, ABVP. Polyuria increased volume of urine Polydipsia increased intake of water. normal water intake = ~1-2 ml/kg/hr normal urine production = ~1-2 ml/kg/hr. Polyuria:Polydipsia.

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Problem-oriented approach to Polyuria:Polydipsia

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  1. Problem-oriented approach to Polyuria:Polydipsia Jill McClure, DVM, MS Diplomate ACVIM, ABVP

  2. Polyuriaincreased volume of urinePolydipsiaincreased intake of water • normal water intake = ~1-2 ml/kg/hr • normal urine production = ~1-2 ml/kg/hr

  3. Polyuria:Polydipsia • either PU or PD can be primary with the other a secondary response • PD without PU may accompany some conditions • Foals normally have dilute, hyposthenuric urine

  4. water diuresis excessive H2O intake ADH deficiency ADH unresponsive ADH inhibition medullary washout solute diuresis non-absorbable solute excessive absorbable solute defective proximal tubule medullary washout aldosterone deficiency Mechanisms of Diuresis

  5. History appetite previous disease previous drug therapy hair coat changes attitude and neurologic status Physical Exam document problem hydration status mucous membranes external genitalia rectal exam edema musculo-skeletal problems Minimum data base for PU:PD

  6. Minimum database for PU:PD • Laboratory • CBC • BUN, creatinine • Albumin, protein • blood glucose • Electrolytes (Na,Cl,K,HCO3) • Minerals (Ca,P) • UA with fractional excretions

  7. Expanded database for PU:PD • water deprivation test • ultrasound • --------------------------- • glucose tolerance • sodium sulfanilite clearance • insulin challenge • assays for toxins • renal biopsy

  8. Polyuria:Polydipsia

  9. Polyuria:Polydipsia

  10. Polyuria:Polydipsia

  11. Polyuria:Polydipsia

  12. Idiopathic psychogenic H2O drinker psychogenic salt eater CRF due to glomerulonephritis Metabolic hypercalcemia 2o to renal disease Polyuria:Polydipsia

  13. Iatrogenic IV fluid overload diuretics Neoplastic pituitary adenoma Polyuria:Polydipsia

  14. Toxic aminoglycosides NSAIDS cantharidin pigmenturia Vascular hypovolemia Polyuria:Polydipsia

  15. Polyuria:Polydipsia • Inflammatory/infectious • pyelonephritis • Corynebacterium renale • Streptococcus • immune complex glomerulonephritis

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