Diabetes insipidus
Hypotonic polyuria from AVP deficiency (cranial) or AVP resistance (nephrogenic). Exclude glucose, calcium and potassium causes, separate it from primary polydipsia with stimulated copeptin or water deprivation, treat AVP deficiency with desmopressin and never omit it in hospital.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Polyuria (over 3 L a day, or about 50 mL/kg) of dilute urine (osmolality under 300 mOsm/kg).
- Since 2022: AVP deficiency (AVP-D) replaces cranial DI and AVP resistance (AVP-R) replaces nephrogenic DI, partly to stop confusion with diabetes mellitus in hospital.
- The main differential is primary polydipsia, where drinking drives the polyuria and sodium is low-normal.
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Sources
- Arima H, Cheetham T, Christ-Crain M et al. Changing the name of diabetes insipidus: a position statement of the Working Group for Renaming Diabetes Insipidus. J Clin Endocrinol Metab 2023;108:1-3Working Group for Renaming Diabetes Insipidus (international endocrine societies), 2022 (published 2023)
- Fenske W, Refardt J, Chifu I et al. A copeptin-based approach in the diagnosis of diabetes insipidus. N Engl J Med 2018;379:428-39New England Journal of Medicine, 2018
- Winzeler B, Cesana-Nigro N, Refardt J et al. Arginine-stimulated copeptin measurements in the differential diagnosis of diabetes insipidus. Lancet 2019;394:587-95The Lancet, 2019
- Refardt J, Atila C, Chifu I et al. Arginine or hypertonic saline-stimulated copeptin to diagnose AVP deficiency. N Engl J Med 2023;389:1877-87New England Journal of Medicine, 2023
- Atila C, Refardt J, Christ-Crain M. Arginine vasopressin deficiency and oxytocin deficiency in the endocrine clinic. J Clin Endocrinol Metab 2026;111(4):922-37Journal of Clinical Endocrinology and Metabolism, 2026
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback