STUDY - Technical - New Dacian's Medicine
Polyuria
(Classical / Allopathic Medicine)
A
relatively common sign, of polyuria, is the daily
production and excretion of more than 3,000 ml of urine.
It's usually reported by the patient as increased
urination, especially when it occurs at night. Polyuria is
aggravated by overhydration, consumption of caffeine or
alcohol, and excessive ingestion of salt, glucose, or
other hyperosmolar substances.
Polyuria
may result from the use of particular drugs (such as
diuretics) or from a psychological, neurologic, or renal
disorder. It can reflect central nervous system
dysfunction that diminishes or suppresses the secretion of
antidiuretic hormone (ADH), which regulates fluid balance.
Alternatively, when ADH levels are normal, it can reflect
renal impairment. In both of these pathophysiologic
mechanisms, the renal tubules fail to reabsorb sufficient
water, causing polyuria.
ALERT:
If the patient complains of polyuria:
- check the patient's vital signs, noting decreased blood pressure or increased heart rate
- evaluate the patient's level of consciousness
- check for cool, clammy skin
- institute emergency measures, if appropriate.
If the patient doesn't display signs of hypovolemia, perform a focused assessment.
If the patient complains of polyuria:
- check the patient's vital signs, noting decreased blood pressure or increased heart rate
- evaluate the patient's level of consciousness
- check for cool, clammy skin
- institute emergency measures, if appropriate.
If the patient doesn't display signs of hypovolemia, perform a focused assessment.
HISTORY:
Explore the frequency and pattern of the polyuria. Ask the patient when it began and how long it has lasted. Also, ask him if it was precipitated by a certain event.
Ask the patient to describe the pattern and amount of his daily fluid intake.
Review the patient's medical history for visual deficits, headaches, or head trauma, which may precede diabetes insipidus; urinary tract obstruction or infection; diabetes mellitus; renal disorders; chronic hypokalemia or hypercalcemia; and psychiatric disorders.
Ask the patient what medications he's taking, including dosages and schedules.
Ask the patient if he's unusually tired or thirsty.
Ask the patient if he has recently lost more than 5% of his body weight.
Explore the frequency and pattern of the polyuria. Ask the patient when it began and how long it has lasted. Also, ask him if it was precipitated by a certain event.
Ask the patient to describe the pattern and amount of his daily fluid intake.
Review the patient's medical history for visual deficits, headaches, or head trauma, which may precede diabetes insipidus; urinary tract obstruction or infection; diabetes mellitus; renal disorders; chronic hypokalemia or hypercalcemia; and psychiatric disorders.
Ask the patient what medications he's taking, including dosages and schedules.
Ask the patient if he's unusually tired or thirsty.
Ask the patient if he has recently lost more than 5% of his body weight.
PHYSICAL
ASSESSMENT:
Evaluate fluid status first. Take vital signs, especially noting an increased body temperature, tachycardia, or orthostatic hypotension.
Check for dry skin and mucous membranes, decreased skin turgor and elasticity, and reduced perspiration.
Perform a neurologic examination, noting especially changes in the patient's level of consciousness.
Palpate the bladder and inspect the urethral meatus. Obtain a urine specimen, and check its specific gravity.
Evaluate fluid status first. Take vital signs, especially noting an increased body temperature, tachycardia, or orthostatic hypotension.
Check for dry skin and mucous membranes, decreased skin turgor and elasticity, and reduced perspiration.
Perform a neurologic examination, noting especially changes in the patient's level of consciousness.
Palpate the bladder and inspect the urethral meatus. Obtain a urine specimen, and check its specific gravity.
SPECIAL
CONSIDERATIONS:
Maintaining an adequate fluid balance is your primary concern when the patient has polyuria. Monitor intake and output and weight.
Maintaining an adequate fluid balance is your primary concern when the patient has polyuria. Monitor intake and output and weight.
PEDIATRIC
POINTERS:
The major causes of polyuria in children are congenital nephrogenic diabetes insipidus, medullary cystic disease, polycystic renal disease, and distal renal tubular acidosis.
Because a child's fluid balance is more delicate than an adult's, check his urine specific gravity at each voiding, and be alert for signs of dehydration, such as decreased body weight, decreased skin turgor, dry mucous membranes, decreased urine output, absence of tears when crying, and pale, mottled, or gray skin.
The major causes of polyuria in children are congenital nephrogenic diabetes insipidus, medullary cystic disease, polycystic renal disease, and distal renal tubular acidosis.
Because a child's fluid balance is more delicate than an adult's, check his urine specific gravity at each voiding, and be alert for signs of dehydration, such as decreased body weight, decreased skin turgor, dry mucous membranes, decreased urine output, absence of tears when crying, and pale, mottled, or gray skin.
AGING
ISSUES:
In elderly patients, chronic pyelonephritis is commonly associated with a lymphoproliferative disorder. The possibility of associated malignant disease must be investigated.
In elderly patients, chronic pyelonephritis is commonly associated with a lymphoproliferative disorder. The possibility of associated malignant disease must be investigated.
PATIENT
COUNSELING:
Advise the patient to decrease his intake of caffeine, alcohol, salt, and sugar, and to avoid drinking fluids right before bedtime.
Advise the patient to decrease his intake of caffeine, alcohol, salt, and sugar, and to avoid drinking fluids right before bedtime.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.