Diabetes insipidus and SIADH Quiz: Ace Your Exams
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A 33-year-old man comes to the emergency department because of increased urination and constant thirst despite drinking more than 7 liters of water each day. The symptoms began two weeks ago. Past medical history is notable for bipolar disorder and type 2 diabetes mellitus. The patient takes lithium and metformin. At the time of arrival, temperature is 37.0°C (98.6°F), pulse is 75/min, and blood pressure is 125/78 mmHg. The remainder of the examination is noncontributory. Laboratory results are as follows:
A trial of vasopressin is administered. However, there is no significant increase in urine osmolality within 2 hours. Which of the following best describes the most likely pathophysiology of this patient’s presentation?
| Laboratory value | Result | Reference Range |
| Sodium | 154 mEq/L | 136-146 mEq/L |
| Potassium | 3.9 mEq/L | 3.5-5 mEq/L |
| Glucose | 118 mg/dL | 70-110 mg/dL |
| Creatinine | 0.9 mg/dL | 0.6-1.2 mg/dL |
| HbA1c | 6.7% | ≤6% |
| Serum Osmolarity | 325 mOsm/kg | 275-295 mOsm/kg |
| Urine Osmolality | 115 mOsm/kg | 50-1400 mOsm/kg |
A trial of vasopressin is administered. However, there is no significant increase in urine osmolality within 2 hours. Which of the following best describes the most likely pathophysiology of this patient’s presentation?
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