Childhood diabetes insipidus

　　There are many causes of diabetes insipidus. Diabetes insipidus is generally divided into primary diabetes insipidus, secondary diabetes insipidus, and hereditary diabetes insipidus. Clinically, it can be divided into central diabetes insipidus and renal diabetes insipidus.

　　1. Central diabetes insipidus (ADH deficiency diabetes insipidus)

　　Central diabetes insipidus is caused by a lack of ADH. Lesions in any part of the hypothalamus and pituitary can cause diabetes insipidus. Among them, the most common are maldevelopment or degenerative changes in the supraoptic nucleus and paraventricular nucleus of the hypothalamus, accounting for about 50% of previous reports. Hereditary (familial) diabetes insipidus is less common, accounting for about 1%, and is generally autosomal dominant inheritance. In central diabetes insipidus, some cases are caused by various intracranial lesions, such as tumors (commonly craniopharyngiomas and pineal tumors, accounting for about 70%), granulomas, inflammation, cranial and brain trauma, cerebrovascular diseases, surgery, or cranial radiotherapy, which can all cause diabetes insipidus. Among them, those caused by tumors account for at least 30% in children. Hypoxemia and ischemic hypoxic encephalopathy in the neonatal period can lead to diabetes insipidus in childhood.

　　2、肾源性尿崩症

　　2, Nephrogenic diabetes insipidus

　　Inadequate water intake can lead to symptoms of hyperosmotic dehydration such as fever, constipation, and weight loss, and severe cases can lead to convulsions or coma. Diabetes insipidus can also lead to complications such as renal pelvis dilation, ureteral dilation, and even renal insufficiency. Clinical complications can include renal and ureteral dilation and bladder dilation.

　　The clinical manifestations of pediatric diabetes insipidus mainly include the following types:

　　1, Polyuria or enuresis

　　Polyuria or enuresis is often the first symptom discovered by parents. The number of times and the amount of urine the child urinates increase, with daily urine output often exceeding 4L. In severe cases, it can reach over 10L. The color of morning urine can be as light as water.

　　2, Polydipsia

　　Infants show a preference for drinking water over breastfeeding. Children generally prefer cold water, even in winter, and love to drink cold water. The amount of water they drink is roughly equal to the amount of urine. If they do not drink water, they may have an intolerable thirst, but the urine output does not decrease.

　　3, Other

　　Children can drink water sufficiently and generally have no other symptoms. Infants who cannot drink water appropriately often have symptoms such as restlessness, sleeplessness at night, fever, constipation, weight loss, and dry skin, which are manifestations of hyperosmotic dehydration. Severe cases can lead to convulsions and coma. Long-term polyuria and polydipsia can lead to growth disorders, renal pelvis积水, and ureteral dilation, and even renal insufficiency. Secondary diabetes insipidus caused by intracranial tumors can also have symptoms of increased intracranial pressure, such as headache, vomiting, and visual disturbances. Renal diabetes insipidus is more common in males, has a family history, and has an earlier onset age.

　　The etiology of pediatric diabetes insipidus is divided into primary and secondary types. The primary type has an unknown etiology, while the secondary type is commonly caused by tumors, trauma, infection, and other factors. Therefore, it is very important to prevent the etiology of secondary diabetes insipidus. Early detection, early treatment of related etiologies, and attention to the following points are necessary:

　　Avoid long-term mental stimulation.Long-term mental stimulation (such as fright, sadness, anxiety, or nervous tension) can cause functional disorders of the cerebral cortex, leading to endocrine disorders, causing the secretion of antidiuretic hormone to become more abundant, increasing urine output, and exacerbating the disease.

　　Avoid high-protein, high-fat, spicy, and high-sodium foods, as well as smoking and drinking alcohol.These foods can increase plasma osmotic pressure, thereby exciting the brain's thirst center and helping to generate heat, drying up the yin, and exacerbating symptoms such as thirst in this disease.

　　Avoid drinking tea and coffee.Tea and coffee contain caffeine and theophylline, which can stimulate the central nervous system, enhance myocardial contractility, dilate the kidneys and surrounding blood vessels, thereby exerting a diuretic effect, increasing urine output, and exacerbating the disease.

　　In addition to relying on clinical characteristics, the diagnosis of pediatric diabetes insipidus also relies on the results of chemical tests. The main inspection methods are as follows:

　　1. Urine Examination

　　Urine specific gravity below 1.005, urine osmolality below 200 mOsm/(kg·H2O), given solute diuresis, which can only reach 280-300 mOsm/(kg·H2O).

　　2. Blood Tests

　　Children may have hypernatremia, hyperchloremia, and other conditions.

　　3. Renal Function and Electrolyte Examination

　　If there is kidney involvement, there may be varying degrees of renal function abnormalities. Patients with diabetes insipidus usually have normal urine routine, negative urine sugar, and normal or slightly high blood sodium.

　　Pediatric diabetes insipidus patients should eat high-protein and nutritious foods, easily digestible high-calorie foods, and foods rich in vitamins and minerals. They should avoid eating fried, smoked, grilled, cold, stimulating, high-salt, and high-fat foods.

　　When treating pediatric diabetes insipidus in traditional Chinese medicine, different methods are adopted according to different patterns. The patterns of diabetes insipidus mainly include the following two types:

　　1. Qi and Yin Deficiency

　　ManifestationExcessive drinking and urination, fatigue, spontaneous sweating, shortness of breath, exacerbation upon movement, dry mouth and tongue, interior heat, constipation, soreness in the loins and knees, pale red and dark tongue, tooth mark on the edge of the tongue, thin white fur, and weak pulse.

　　Therapeutic MethodNourish Qi and Yin.

　　Prescription MedicineSix-Ingredient Rehmannia Pill with Modification (Raw Rehmannia 25 grams, Schisandra 16 grams, Chinese yam 25 grams, Poria 12 grams, Alisma 12 grams, Astragalus 35 grams, Codonopsis 16 grams, Atractylodes 12 grams, and Scrophularia 25 grams).

　　2. Both Yin and Yang Deficiency

　　ManifestationExcessive drinking and urination, turbid and greasy, fatigue, spontaneous sweating, cold limbs, ashen complexion, soreness in the loins and knees, dry earlobes, edema and decreased urine, or diarrhea in the early morning, premature ejaculation, pale tongue, white fur, deep and rapid pulse.

　　Therapeutic MethodWarm Yang and Nourish Yin.

　　Prescription MedicineJinkui Shenqi Pill with Modification (Prepared Aconite 12 grams, Cinnamon 4 grams, Raw Rehmannia 25 grams, Schisandra 12 grams, Chinese yam 25 grams, Poria 25 grams, Moutan bark 12 grams, Alisma 12 grams, Astragalus 35 grams, Trichosanthes 16 grams, Alisma orientale 10 grams, and Schisandra chinensis 16 grams).