Polyuria and Medications Quiz
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Polyuria and Medications Quiz

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@IndebtedJadeite

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Questions and Answers

What is the main cause of polyuria?

  • Primary polydipsia
  • Diabetes mellitus
  • All of the above (correct)
  • Diabetes insipidus

    • What is the definition of polyuria in adults?

  • More than 5 liters/day
  • Less than 3 liters/day
  • Exactly 3 liters/day
  • More than 3 liters/day (correct)

    • What is the volume of excessive urination for adults?

  • >1 liter/day
  • >2 liters/day
  • >4 liters/day
  • >3 liters/day (correct)

    • What are the main causes of polyuria?

    <p>Diabetes insipidus, diabetes mellitus, primary polydipsia, and drug-induced polyuria</p> Signup and view all the answers

    What is the purpose of the water deprivation test?

    <p>To differentiate between diabetes insipidus and primary polydipsia</p> Signup and view all the answers

    What is the purpose of the water deprivation test?

    <p>To diagnose diabetes insipidus</p> Signup and view all the answers

    Which medication is a loop diuretic?

    <p>Furosemide</p> Signup and view all the answers

    What is the mechanism of action of furosemide?

    <p>Inhibits Sodium-Potassium-Chloride co-transporter in the Loop of Henle</p> Signup and view all the answers

    What are the effects of spironolactone?

    <p>Polyuria (less likely than furosemide), urinary frequency (less likely than furosemide), increase in serum potassium</p> Signup and view all the answers

    What is the mechanism of action of spironolactone?

    <p>Competitive binding of receptors at aldosterone-dependent potassium exchange in the distal convoluted renal tubule</p> Signup and view all the answers

    What is the dose adjustment consideration for furosemide?

    <p>Decrease the dose if the patient is euvolemic and shows no signs of heart failure</p> Signup and view all the answers

    What is the recommended dose adjustment for furosemide in euvolemic patients?

    <p>Decrease the dose</p> Signup and view all the answers

    What is the mechanism of action of levothyroxine that can cause polyuria and urinary frequency?

    <p>Downregulation of aquaporin 1 and 2</p> Signup and view all the answers

    What is the effect of levothyroxine on aquaporin 1 and 2?

    <p>Downregulation</p> Signup and view all the answers

    What is the recommended dose adjustment for spironolactone in patients with heart failure?

    <p>Continue the current dose</p> Signup and view all the answers

    What is the effect of spironolactone on serum potassium?

    <p>Increase</p> Signup and view all the answers

    What is the recommended treatment for primary polydipsia?

    <p>Fluid restriction and addressing underlying psychiatric issues</p> Signup and view all the answers

    What is the effect of furosemide on sodium, chloride, and potassium in urine?

    <p>Increase</p> Signup and view all the answers

    What is the effect of levothyroxine on urine flow?

    <p>Increase</p> Signup and view all the answers

    What is the purpose of the desmopressin test?

    <p>To differentiate central and nephrogenic diabetes insipidus</p> Signup and view all the answers

    What is the effect of spironolactone on polyuria?

    <p>Less likely than furosemide</p> Signup and view all the answers

    What are the effects of furosemide?

    <p>Polyuria, urinary frequency, loss of sodium, chloride, and potassium in urine</p> Signup and view all the answers

    What is the recommended dose adjustment for levothyroxine in patients with suppressed TSH?

    <p>Decrease the dose</p> Signup and view all the answers

    What is the effect of levothyroxine on serum calcium?

    <p>No effect</p> Signup and view all the answers

    Study Notes

    Approach for Polyuria and Medications that Cause Polyuria

    I. Introduction

    • Polyuria is excessive urination (>3 liters/day for adults)
    • Main causes include diabetes insipidus (DI), diabetes mellitus (DM), primary polydipsia (PP), and drug-induced polyuria

    II. Initial Assessment

    • Full history and physical exam, including vital signs, cardiac, respiratory, abdominal, and fluid status
    • Pelvic exam if concerns of incontinence or urogynecologic issues
    • Current medical conditions
    • Investigations, including urine dipstick, blood glucose measurement, serum electrolytes, osmolality and creatinine, urine electrolytes and osmolality

    III. Urine Analysis

    • Urinalysis to assess for glucosuria or proteinuria
    • Low specific gravity (<1.005) is indicative of DI or PP
    • Glucosuria and high specific gravity (>1.015) is suggestive of DM

    IV. Water Deprivation Test

    • Purpose is to differentiate between DI and PP
    • Conducted by withholding fluids for 8 hours and measuring plasma and urine osmolality
    • Precautions should be taken due to dehydration risk

    V. Additional Testing

    • Serum glucose for DM, serum calcium for hypercalcemia, renal function tests, hormone levels, and imaging
    • Desmopressin test to observe urine osmolality change to differentiate central and nephrogenic DI

    VI. Treatment

    • Desmopressin for DI, insulin therapy or oral hypoglycemic agents for DM, fluid restriction and addressing underlying psychiatric issues for PP, and adjusting or changing medication for drug-induced polyuria

    Medications that Cause Polyuria: I. Furosemide

    • Type: Loop diuretic
    • Mechanism of action: inhibits Sodium-Potassium-Chloride co-transporter in the Loop of Henle, reduces water resorption
    • Effects: polyuria, urinary frequency, loss of sodium, chloride, and potassium in urine
    • Dose adjustment considerations: maintain the patient on the smallest dose possible to achieve euvolemia, decrease the dose if the patient is euvolemic and shows no signs of heart failure

    II. Spironolactone

    • Type: Aldosterone antagonist
    • Mechanism of action: competitive binding of receptors at aldosterone-dependent potassium exchange in the distal convoluted renal tubule
    • Effects: polyuria (less likely than furosemide), urinary frequency (less likely than furosemide), increase in serum potassium
    • Dose adjustment considerations: continue the current dose or higher to see benefits for heart failure

    III. Levothyroxine

    • Type: Thyroid supplement
    • Mechanism of action: can cause polyuria and urinary frequency when it causes hyperthyroidism (e.g. toxicity), downregulation of aquaporin 1 and 2, increased blood pressure and food and water intake, increased distal delivery of sodium, resulting in increased urine flow
    • Effects: polyuria, urinary frequency
    • Dose adjustment considerations: perform lab work for thyroid-stimulating hormone (TSH), if TSH is suppressed (suggesting oversupplementation), reduce the levothyroxine dose.

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    Description

    Think you know how to approach polyuria and identify medications that cause it? Test your knowledge with this quiz! From conducting initial assessments to performing water deprivation tests, this quiz covers everything you need to know about identifying and treating polyuria. Plus, learn about common medications that can cause polyuria and how to adjust their doses accordingly. Test your skills and see how much you know about this common medical condition.

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