Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

472 Diabetes Insipidus Diabetes Mellitus, Type 1

complications and prognosis

■Overtreatment causes hyponatremia and altered mental status

■Undertreatment leads to persistent DI: oral DDAVP may not be ade-

quate, nasal spray has variable absorption

■Patients require lifelong observation

■If idiopathic, other pituitary deficiencies unlikely

■May occur transiently after pituitary surgery, then may be followed

by SIADH within 1 wk; SIADH may resolve or revert to permanent

DI (“triple response”)

■DI during pregnancy from increased vasopressinase resolves post-

partum

■Initiation of glucocorticoid and thyroid hormone replacement in

hypopituitarism may unmask or markedly worsen DI

■Lithium-induced nephrogenic DI may persist long after drug

stopped

Diabetes Mellitus, Type 1...............................

FREDRIC B. KRAEMER, MD

history & physical

History

■Known type 1 diabetes

■Family history of type 1 diabetes

■Recent history of mumps or viral infection

■Pancreatectomy

Signs & Symptoms

■Presentation: polyuria, polydipsia, nocturia, polyphagia, weight loss,

fatigue, blurred vision, candidiasis, recurrent furunculosis

■Diabetic ketoacidosis (DKA):

■Symptoms: polyuria, polydipsia, nocturia, polyphagia, weight loss,

fatigue, abdominal pain, nausea/vomiting, weakness, drowsiness,

stupor, coma

■Signs: tachycardia, hypothermia, dehydration, Kussmaul respira-

tion, altered mental status

Established disease:

■Visual changes: blurred vision, floating specks, loss of vision

■Paresthesias, numbness, lancinating, burning/aching pain, cold-

ness, usually affecting lower extremities, usually worse at night