Nephrogenic diabetes insipidus (DI) occurs when the renal tubules are unresponsive to circulating antidiuretic hormone (ADH).


Clinical findings:

(1) polyuria

(2) polydipsia

(3) dehydration

(4) altered mental status progressing to coma (encephalopathy)

(5) seizures

(6) lethargy and weakness


Laboratory findings:

(1) dilute urine (osmolality < 250 mOsm per kg water)

(2) serum hypernatremia

(3) serum hyperosmolality (> 292 mOsm per kg water)

(4) serum ADH normal to elevated


Central DI

Nephrogenic DI

serum ADH


normal to elevated

response to subcutaneous vasopressin or desmopressin

clinical response

no response


A patient with nephrogenic diabetes responds to:

(1) discontinuation of cause if identifiable

(2) salt restriction

(3) thiazide diuretics


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