Editing Polyuria

{{Short description|Excess urination}}
{{Distinguish|polyurea|Frequent urination}}
{{Infobox medical condition (new)
| name            =
| image           = ADH3.svg
| caption         = Regulation of urine production by ADH and aldosterone
| field           = [[Endocrinology]], [[nephrology]]|
| synonyms      = Urination - excessive amount<ref name=ur/>
| complications   =
| onset           =
| duration        =
| types           =
| causes          = Polydipsia, Psychogenic polydipsia<ref name=ref/><ref name=ref2/>
| risks           =
| diagnosis       =  Urine test and blood test<ref name=pat/>
| differential    =
| prevention      =
| treatment       = Depends on cause<ref name=uro/>(See cause)
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}

'''Polyuria''' ({{IPAc-en|ˌ|p|ɒ|l|i|ˈ|jʊər|i|ə}}) is excessive or an abnormally large production or [[Frequent urination|passage]] of [[urine]] (greater than 2.5 L<ref name="ur">{{Cite web |date=27 December 2013 |title=Urination – excessive amount |url=https://www.nlm.nih.gov/medlineplus/ency/article/003146.htm |access-date=30 December 2014 |website=Medline Plus |publisher=United States National Library of Medicine}}</ref> or 3 L<ref name="merck">{{Cite web |date=November 2013 |title=Polyuria |url=http://www.merckmanuals.com/professional/genitourinary_disorders/symptoms_of_genitourinary_disorders/polyuria.html |access-date=30 December 2014 |website=Merck Manuals}}</ref> over 24 hours in adults). Increased production and passage of urine may also be termed as [[diuresis]].<ref>{{Cite web |date=30 October 2013 |title=Definition of Diuresis |url=http://www.medicinenet.com/script/main/art.asp?articlekey=21221 |access-date=30 December 2014 |website=MedTerms}}</ref><ref>{{Cite web |title=Diuresis |url=http://medical-dictionary.thefreedictionary.com/diuresis |access-date=30 December 2014 |website=The Free Dictionary}}</ref> Polyuria often appears in conjunction with [[polydipsia]] (increased thirst), though it is possible to have one without the other, and the latter may be a cause or an effect. [[Primary polydipsia]] may lead to polyuria.<ref>{{Cite book |last=Parthasarathy |first=A. |url=https://books.google.com/books?id=i_2YAwAAQBAJ&q=primary%2520polydipsia%2520causes%2520polyuria&pg=PA352 |title=Case Scenarios in Pediatric and Adolescent Practice |date=2014-04-30 |publisher=JP Medical Ltd |isbn=9789351520931}}</ref> Polyuria is usually viewed as a [[symptom]] or [[Medical sign|sign]] of another [[Disease|disorder]] (not a disease by itself), but it can be classed as a disorder, at least when its underlying causes are not clear.{{citation needed|date=September 2016}}

==Causes==
The most common cause of polyuria in both adults and children is uncontrolled [[diabetes mellitus]],<ref name=merck/> which causes [[osmotic diuresis]]; when glucose levels are so high that [[glycosuria|glucose is excreted in the urine]]. Water follows the glucose concentration passively, leading to abnormally high urine output.{{cn|date=September 2024}}

In the absence of diabetes mellitus, the most common causes are the decreased secretion of [[aldosterone]] due to adrenal cortical tumor, [[primary polydipsia]] (excessive fluid [[drinking]]), [[central diabetes insipidus]], and [[nephrogenic diabetes insipidus]].<ref name="merck" /> Polyuria may also be due to various chemical substances, such as [[diuretic]]s, [[caffeine]], and [[ethanol]]. It may also occur after [[supraventricular tachycardia]]s, during an onset of [[atrial fibrillation]], [[childbirth]], and the removal of an obstruction within the [[urinary tract]]. Diuresis is controlled by [[antidiuretic]]s such as [[vasopressin]], [[angiotensin II]] and [[aldosterone]]. ''Cold diuresis'' is the occurrence of increased urine production upon exposure to cold, which also partially explains [[immersion diuresis]]. ''High-altitude diuresis'' occurs at altitudes above {{convert|10000|ft|m}} and is a desirable indicator of [[high-altitude adaptation|adaptation to high altitudes]]. Mountaineers who are adapting well to high altitudes experience this type of diuresis. People who produce less urine even in the presence of adequate fluid intake are probably not adapting well to high altitudes.<ref>{{Citation |last=Research |first=Institute of Medicine (US) Committee on Military Nutrition |title=Fluid Metabolism at High Altitudes |date=1996 |work=Nutritional Needs in Cold and in High-Altitude Environments: Applications for Military Personnel in Field Operations |url=https://www.ncbi.nlm.nih.gov/books/NBK232881/ |access-date=2024-03-04 |publisher=National Academies Press (US) |language=en |last2=Marriott |first2=Bernadette M. |last3=Carlson |first3=Sydne J.}}</ref>

[[File:Bacteriuria pyuria 4.jpg|thumb|Urinary tract infection (bacteria are black and bean-shaped)]]

===List of causes===
[[File:Emphysematous cystitis - X-rax - SHF.jpg|thumb|Emphysematous cystitis]]
[[File:Lithium-carbonate2DCSD.svg|thumb|Lithium-carbonate]]
{{col-list|colwidth=30em|
'''General'''
* [[polydipsia]]<ref name="ref2">{{Cite book |url=https://books.google.com/books?id=ooH1nH81_h4C&q=polydipsia++causes+polyuria&pg=PA909 |title=Irwin and Rippe's intensive care medicine |date=2008 |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |isbn=978-0-7817-9153-3 |editor-last=Irwin |editor-first=Richard S. |edition=6th |location=Philadelphia |page=909 |access-date=5 August 2015 |editor-last2=Rippe |editor-first2=James M.}}</ref>
* [[psychogenic polydipsia]]<ref name="ref">{{Cite book |last=Rudolf |first=Mary |url=https://books.google.com/books?id=eAAgon-AtoAC&q=psychogenic+polydipsia+causes+polyuria&pg=PA142 |title=Paediatrics and Child Health |date=2006 |publisher=Wiley |isbn=9781444320664 |edition=2nd |page=142 |access-date=5 August 2015}}</ref>
* [[diuretic]] drugs, [[osmotic diuresis]]<ref>{{Cite book |last=Ronco |first=Claudio |url=https://books.google.com/books?id=XkKn96HThzEC&q=diuresis+causes+polyuria&pg=PA475 |title=Critical Care Nephrology |date=2009 |publisher=Saunders |isbn=978-1416042525 |edition=2nd |page=475 |access-date=5 August 2015}}</ref>

'''Urinary system'''
* [[interstitial cystitis]]<ref>{{Cite book |last=Paulman |first=Paul |url=https://books.google.com/books?id=SW87MoaaIaAC&q=interstitial+cystitis+causes+polyuria&pg=PA432 |title=Signs and Symptoms in Family Medicine: A Literature-Based Approach |date=2012 |publisher=Elsevier |isbn=978-0323081320 |page=432 |access-date=5 August 2015}}</ref>
* [[urinary tract infection]]<ref>{{Cite book |last=Drake |first=William M. |url=https://books.google.com/books?id=fExzRaEuPC8C&q=urinary+tract+infection+causes+polyuria&pg=PA378 |title=Hutchison's clinical methods : an integrated approach to clinical practice |last2=Hutchison |first2=Robert |date=2012 |publisher=Elsevier |isbn=978-0-7020-4091-7 |edition=23rd |location=Edinburgh |page=378 |access-date=5 August 2015}}</ref>
* [[renal tubular acidosis]]<ref>{{Cite book |last=Lee |first=Mary |url=https://books.google.com/books?id=5WW1AAAAQBAJ&q=renal+tubular+acidosis+causes+polyuria&pg=PT572 |title=Basic skills in interpreting laboratory data |date=2013 |publisher=American Society of Health-System Pharmacists |isbn=978-1-58528-343-9 |edition=5th |location=Bethesda, Md. |page=132 |access-date=5 August 2015}}</ref>
* [[Fanconi syndrome]]<ref>{{Cite book |last=Weissman |first=Barbara N. |url=https://books.google.com/books?id=N94omKNvnVQC&q=Fanconi+syndrome+causes+polyuria&pg=PA679 |title=Imaging of arthritis and metabolic bone disease |date=2009 |publisher=Mosby/Elsevier |isbn=978-0-323-04177-5 |location=Philadelphia, PA |page=679 |access-date=5 August 2015}}</ref>
* [[nephronophthisis]] (genetic)<ref>{{Cite book |url=https://books.google.com/books?id=saPIAwAAQBAJ&q=nephronophthisis+causes+polyuria&pg=PA761 |title=Radiology illustrated : pediatric radiology |date=2013 |publisher=Springer |isbn=978-3-642-35572-1 |edition=1., 2013 |location=[S.l.] |page=761 |access-date=6 August 2015}}</ref>
'''Hormonal'''
* [[hypokalemia]]<ref>{{Cite book |last=Chihan |first=Nina |url=https://books.google.com/books?id=PcARTQwHLpIC&q=psychogenic+polydipsia+causes+polyuria&pg=PA481 |title=Nursing Interpreting Signs and Symptoms |date=2007 |publisher=Lippincott Williams & Wilkins |isbn=9781582556680 |page=481 |access-date=5 August 2015}}</ref>
* [[diabetes mellitus]]<ref>{{Cite book |url=https://books.google.com/books?id=OdjaAAAAQBAJ&q=chronic+renal+failure+causes+polyuria&pg=PA411 |title=Clinical chemistry: a laboratory perspective |date=2007 |publisher=F.A. Davis Co |isbn=978-0-8036-1498-7 |editor-last=Arneson |editor-first=Wendy |location=Philadelphia |page=411 |oclc=ocm76901872 |access-date=5 August 2015 |editor-last2=Brickell |editor-first2=Jean}}</ref>
* [[corticosteroid]] use<ref>{{Cite book |last=Soni |first=Andrew Bersten, Neil |url=https://books.google.com/books?id=xXyzAQAAQBAJ&q=corticosteroid+causes+polyuria&pg=PA643 |title=Oh's Intensive Care Manual |date=2013 |publisher=Elsevier Health Sciences |isbn=978-0-7020-4762-6 |edition=7. |location=London |page=643 |access-date=6 August 2015}}</ref>
* [[pheochromocytoma]]<ref>{{Cite web |title=Pediatric Pheochromocytoma Clinical Presentation |url=http://emedicine.medscape.com/article/988683-clinical |access-date=6 August 2015 |website=Medscape.com |publisher=eMedicine}}</ref>
* [[hyperparathyroidism]]<ref>{{Cite book |last=Ghosh |first=Srinanda |url=https://books.google.com/books?id=7fFV0QcLLCoC&q=hyperparathyroidism+causes+polyuria&pg=PA150 |title=MCQ's in medical surgical nursing : (with explanatory answers) |date=2007 |publisher=Jaypee Bros. Medical Publishers (P) Ltd. |isbn=978-81-8448-104-4 |edition=1st |location=New Delhi, India |page=150 |access-date=6 August 2015}}</ref>
* [[diabetes insipidus]]<ref>{{Cite book |last=Singh |first=Ajay K. |url=https://books.google.com/books?id=21bCBwAAQBAJ&q=acromegaly+causes+polyuria&pg=PA551 |title=The Brigham intensive review of internal medicine |last2=Loscalzo |first2=Joseph |date=2014 |publisher=Oxford University Press |isbn=978-0-19-935828-1 |edition=Second |page=551 |access-date=6 August 2015}}</ref>
* [[hypercalcaemia]]<ref>{{Cite book |url=https://books.google.com/books?id=md-tBwAAQBAJ&q=hypercalcaemia+causes+polyuria&pg=PA312 |title=Acute medicine 201415 |date=2014 |publisher=Scion |isbn=978-1-907904-25-7 |location=[S.l.] |page=312 |access-date=6 August 2015}}</ref>
* [[hyperthyroidism]]<ref>{{Cite journal |last=Mariani |first=Laura |date=2007 |title=The Renal Manifestations of Thyroid Disease |url=http://jasn.asnjournals.org/content/23/1/22.full |journal=Journal of the American Society of Nephrology |volume=23 |issue=1 |pages=22–26 |doi=10.1681/ASN.2010070766 |pmid=22021708 |access-date=6 August 2015 |doi-access=free}}</ref>
* [[hypopituitarism]]<ref>{{Cite web |title=Panhypopituitarism Clinical Presentation |url=http://emedicine.medscape.com/article/923789-clinical |access-date=6 August 2015 |website=Medscape.com |publisher=eMedicine}}</ref>
* [[Conn's disease]]<ref>{{Cite book |last=Kost |first=Michael |url=https://books.google.com/books?id=QMavPTjZwEkC&q=conn%27s+disease+causes+polyuria&pg=PA43 |title=Moderate sedation/analgesia : core competencies for practice |date=2004 |publisher=Saunders |isbn=978-0-7216-0324-7 |edition=2nd |location=St. Louis, Missouri. |page=43 |access-date=6 August 2015}}</ref>
* [[hyperglycaemia]]<ref>{{Cite book |url=https://books.google.com/books?id=v7pbSFfMHCoC&q=hyperglycemia+causes+polyuria&pg=PA270 |title=The 5-minute pediatric consult |date=2012 |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |isbn=978-1-4511-1656-4 |editor-last=Schwartz |editor-first=M. William Schwartz |edition=6th |location=Philadelphia |page=270 |access-date=6 August 2015 |display-editors=etal}}</ref>
'''Circulation'''
* [[congestive heart failure]]<ref>{{Cite book |last=Abrams |first=Paul |url=https://books.google.com/books?id=vp20IgaT6ZYC&q=congestive+heart++failure++healing+period+causes+polyuria&pg=PA120 |title=Urodynamics |date=2006 |publisher=Springer |isbn=978-1-85233-924-1 |edition=3. |location=London |page=120 |access-date=6 August 2015}}</ref>
* cardiorespiratory disease<ref>{{Cite book |last=Leslie |first=Shern L. Chew, David |url=https://books.google.com/books?id=8BZVADcIwoYC&q=hypogonadism+causes+polyuria&pg=PA21 |title=Clinical endocrinology and diabetes |date=2006 |publisher=Churchill Livingstone/Elsevier |isbn=978-0443073038 |location=Edinburgh |page=21}}</ref>
* [[postural orthostatic tachycardia syndrome]] (POTS)<ref>{{Cite book |last=Pavord |first=Sherif Gonem; foreword by Ian |url=https://books.google.com/books?id=XgfO4jvuLCYC&q=postural+orthostatic+tachycardia+syndrome++causes+polyuria&pg=PA44 |title=Diagnosis in acute medicine |date=2010 |publisher=Radcliffe Pub. |isbn=978-184619-433-7 |location=Oxford |page=44 |access-date=6 August 2015}}</ref>

'''Neurologic'''
* [[cerebral salt-wasting syndrome]]<ref>{{Cite book |last=Wheeler |first=D.S. |url=https://books.google.com/books?id=oHciBAAAQBAJ&q=cerebral+salt-wasting+syndrome+causes+polyuria&pg=PA635 |title=Pediatric critical care medicine: respiratory, cardiovascular and central nervous systems |last2=Wong |first2=H.R. |last3=Shanley |first3=T.P. |date=2014 |publisher=Springer |isbn=978-1-4471-6355-8 |edition=2nd |location=New York |page=635 |access-date=6 August 2015}}</ref>
* neurologic damage<ref>{{Cite book |last=Parker |first=Rolland S. |url=https://books.google.com/books?id=nWLLBQAAQBAJ&q=head+trauma+causes+polyuria&pg=PA322 |title=Concussive brain trauma neurobehavioral impairment and maladaptation |date=2012 |publisher=CRC Press |isbn=978-1-4200-0798-5 |edition=Second |location=Boca Raton, FL |page=322 |access-date=6 August 2015}}</ref>
* [[migraine]]<ref>{{Cite web |title=Migraine Headache Clinical Presentation |url=http://emedicine.medscape.com/article/1142556-clinical |access-date=6 August 2015 |website=Medscape.com |publisher=eMedicine}}</ref>

'''Other'''
* high doses of [[riboflavin]] (vitamin B<sub>2</sub>)<ref>{{Cite book |last=McKee |first=Mitchell Bebel Stargrove, Jonathan Treasure, Dwight L. |url=https://books.google.com/books?id=49kLK--eumEC&q=high+doses+of+riboflavin+causes+polyuria&pg=PA267 |title=Herb, nutrient, and drug interactions : clinical implications and therapeutic strategies |date=2008 |publisher=Mosby/Elsevier |isbn=978-0-323-02964-3 |location=St. Louis, Mo. |page=267 |access-date=6 August 2015}}</ref>
* high doses of [[vitamin D]]<ref>{{Cite book |url=https://books.google.com/books?id=wSTISCdSIosC&q=high+dose+ascorbic+acid++causes+polyuria&pg=PA205 |title=Nutrition in pediatrics: basic science and clinical applications |date=1997 |publisher=B.C. Decker |isbn=978-1-55009-026-0 |editor-last=Walker |editor-first=W. Allan |edition=2nd |location=Hamilton, Ont |page=205 |access-date=6 August 2015 |editor-last2=Watkins |editor-first2=John B.}}</ref>
* [[altitude diuresis]]<ref>{{Cite book |last=Schwartz |first=R.B. |url=https://books.google.com/books?id=-erLJS_tHcAC&q=altitude+diuresis++causes+polyuria&pg=PA75 |title=Tactical emergency medicine |last2=Schwartz |first2=R.B. |last3=McManus |first3=J.G. |last4=Swienton |first4=R.E. |date=2008 |publisher=Wolters Kluwer/Lippincott Williams & Wilkins |isbn=978-0-7817-7332-4 |location=Philadelphia |page=75 |access-date=6 August 2015}}</ref>
* side effect of [[Lithium pharmacology|lithium]]<ref>{{Cite book |last=Vyas |first=JN |url=https://books.google.com/books?id=9-Dtdb_n3NQC&q=side+effect+of+lithium+causes+polyuria&pg=PA761 |title=Textbook of Postgraduate Psychiatry (2 Vols.) |date=2008 |publisher=Jaypee Brothers Publishing |isbn=978-81-7179-648-9 |page=761 |access-date=6 August 2015}}</ref>
* [[hemochromatosis]]<ref>{{Cite web |title=Hemochromatosis Clinical Presentation |url=http://emedicine.medscape.com/article/177216-clinical |access-date=6 August 2015 |website=Medscape.com |publisher=eMedicine}}</ref>
* ochratoxicosis<ref>{{Cite journal |last=J. W. Bennett |last2=M. Klich |date=2003 |title=Mycotoxins |journal=Clin Microbiol Rev |volume=16 |issue=3 |pages=497–516 |doi=10.1128/CMR.16.3.497-516.2003 |pmc=164220 |pmid=12857779}}</ref>
}}

==Mechanism==
Polyuria, in osmotic cases, increases flow amount in the distal [[nephron]] where flow rates and [[velocity]] are low. The significant pressure increase occurring in the distal nephron takes place particularly in the cortical-collecting ducts. One study from 2008 laid out a hypothesis that hyperglycaemic and osmotic polyuria play roles ultimately in diabetic nephropathy.<ref>{{Cite journal |last=Wang |first=Shinong |last2=Mitu |first2=Grace M. |last3=Hirschberg |first3=Raimund |date=2008-07-01 |title=Osmotic polyuria: an overlooked mechanism in diabetic nephropathy |journal=Nephrology Dialysis Transplantation |volume=23 |issue=7 |pages=2167–2172 |doi=10.1093/ndt/gfn115 |issn=0931-0509 |pmid=18456680 |doi-access=free}}</ref>

==Diagnosis==
Among the possible tests to diagnose polyuria are:<ref name="pat">{{Cite web |title=Polyuria. Medical Professional reference for Polyuria. {{!}} Patient |url=http://patient.info/doctor/polyuria |access-date=2015-11-08 |website=Patient |language=en-GB}}</ref>
{{col-list|colwidth=30em|
* [[Urine test]]
* FBC
* [[Blood]] test
* [[Pituitary]] function test
}}

==Treatment==
Depending on the cause of the polyuria, the adequate treatment should be afforded. According to [[National Institute for Health and Care Excellence|NICE]], desmopressin can be considered for nocturnal polyuria, which can be caused by diabetes mellitus,<ref name="uro">{{Cite book |last=Merseburger |first=Axel S. |url=https://books.google.com/books?id=2UMBBQAAQBAJ&q=diabetes%2520mellitus%2520causes%2520nocturnal%2520polyuria&pg=PA29 |title=Urology at a Glance |last2=Kuczyk |first2=Markus A. |last3=Moul |first3=Judd W. |date=2014-10-21 |publisher=Springer |isbn=9783642548598}}</ref> if other medical treatments have failed. The recommendation had no studies that met the criteria for consideration.<ref>{{Cite web |title=Nocturia and nocturnal polyuria in men with lower urinary tract symptoms: oral desmopressin {{!}} key-points-from-the-evidence {{!}} Advice {{!}} NICE |url=http://www.nice.org.uk/advice/esuom10/chapter/Key-points-from-the-evidence |access-date=2015-08-03 |website=www.nice.org.uk}}</ref>

==See also==
* [[Oliguria]]
* [[Diabetes insipidus]]
* [[Diabetes mellitus]]
* [[Polydipsia]]

==References==
{{Reflist}}

==Further reading==
* {{Cite journal |last=Movig |first=K. L. L. |last2=Baumgarten |first2=R. |last3=Leufkens |first3=H. G. M. |last4=Laarhoven |first4=J. H. M. Van |last5=Egberts |first5=A. C. G. |date=2003-04-01 |title=Risk factors for the development of lithium-induced polyuria |journal=The British Journal of Psychiatry |volume=182 |issue=4 |pages=319–323 |doi=10.1192/bjp.182.4.319 |issn=0007-1250 |pmid=12668407 |doi-access=free}}
* {{Cite book |last=Kreder |first=Karl |url=https://books.google.com/books?id=rbjibqsVYCQC&q=polyuria%2520treatment&pg=PA56 |title=The Overactive Bladder: Evaluation and Management |last2=Dmochowski |first2=Roger |date=2007-07-10 |publisher=CRC Press |isbn=9780203931622}}

==External links==
{{Medical resources |
  Name        = Polyuria|
  Image       =
  Caption     =
  Field       = [[Endocrinology]], [[nephrology]]|
  ICD10       = {{ICD10|R|35||r|30}}|
  ICD9        = {{ICD9|788.42}}|
  MeshID      = D011141|
  MedlinePlus = 003146
}}
{{Scholia|topic}}
{{Urinary system symptoms and signs}}

[[Category:Symptoms and signs: Urinary system]]
[[Category:Health]]