1. Diabetes Insipidus Dr/ Abd Elghany Hefnawy

2. Anti-Diuretic Hormone (ADH) Vasopressin Water retention and reabsorption of sodium

3. Glucose -Bicarbonate -Na Blood -Na & K -Cl Glomerular filteration Ca, Ph, & Mg Na & K

4. Etiology Central Nephrogenic Kidney affections Weak response to ADH Partial or complete failure of release of ADH -Hyperkalemia -Causion’s syndrome

5. Clinical Signs

6. Polydepsia Polyueria Thirst Dehydration Weakness and emaciation

7. Emaciation Urinary incontinence

8. Diagnosis Case history (Etiology and predisposing factors) Clinical signs Laboratory diagnosis Low urine Sp Gr. Water deprivation test Vasopressin Response test

9. Water deprivation test For differentiation between central, nephrogenic DI and Psychogenic polydepsia Withholding of water until loss of 3-5% of body weight Urine Sp Gr is more than 1.035 Administration of ADH and measuring of urine Sp Gr Time of dehydration Urine Sp Gr post- ADH injection Normal40-80 hoursNot increased Central DI3-5 hoursIncreased Nephrogenic DI3-5 hoursNot increased

10. Vasopressin Response test (Therapeutic diagnosis) Administration of 2-3 units of vasopressin (ADH) Temporary disappearance of polyueria with increase urine Sp Gr

11. Treatment & control -Reduction of salty diet with low protein intake -ADH Injection up to 2 unites twice daily -Desmopressin acetate by nasal or ocular drops 1-4 drops /day

12. ItemsDMDIRenal diseases Color of urine Dark yellowLike waterSlight yellow AspectClear Turbid PolyueriaSeverVery severAccording Sp Gr.HighVery LowLow GlucosueriaPresentAbsentAbsente AlbuminAbsenteabsentePresent Differential diagnosis of the causes of polyueria

13. Dwarfism (GH Deficiency) Dr/ Abd Elghany Hefnawy

14. Retardation of growth specially from weaning Retention of the baby coat Symmetrical alopecia Delayed eruption of the permanent teeth Testicular atrophy and abnormal estrous

15. Treatment -Administration of GH 0.1 IU/Kg SC 3 times /week for 4-6 weeks -Sex hormones, thyroxin and glucocorticoids may be used

16. Gigentism (Acromegaly) Dr/ Abd Elghany Hefnawy

17. -Excessive production of progesterone during diestrous -Prolonged adminsteration of progestin for preventing of estrous -Tumor in the pituitary gland Etiology

18. Excessive soft tissue around head and neck Excessive panting Exercise intolerance and fatigue Excessive skin folds Polyueria,polyphagia, polydepsia (Insulin resistant DM) as GH is diabetogenic

19. Diagnosis Clinical signs Laboratory diagnosis Hyperglycemia Hypercholesroterolemia Glucoseueria Increased GH level

20. Treatment -Administration of Insulin therapy to control of hyperglycemia -Overiohisterectomy -Stoppage of progestin therapy -Cobalt irradiation of pituitary tumor

21. QUESTIONS

22. وسائل التواصل Email: abdelghani72@yahoo.comabdelghani72@yahoo.com Abdelghany.hefnawy@bu.edu.eg Facebook abdelghany hefnawy د. عبد الغني حفناوي Web site to download lectures www.bu.edu.eg/staff/abdelghanyhefnawy www.bu.edu.eg/staff/abdelghanyhefnawy (Courses) Tel 01011676482