1996 Volume 39 Issue 12 Pages 919-923
A44-year-old man had been admitted in 1989 for polyuria and polydipsia. His serum ADH levels were low, but his blood sugar levels were within the normal rang. A diagnosis of idiopathic diabetes Insipidus was made, but the patient refused treatment. In October 1994 he began to drink 8 liters of cooling beverages a day. In January 1995, he was brought to the hospital because of a consciousness disturbance. His urine volume was 7 to 8 liters/day and his blood glucose, blood pH and urinary ketone body values were 1025mg/dl, 7.193 and 3+ respectively. The patient was given saline and insulin, and his blood glucose level became normal, but the polyuria and polydipsia failed to improve. His serum C-peptide level gradually improved, and insulin therapy was no longer needed 2 weeks after his admission. A glucose tolerance test showed impaired glucose tolerance6 weeks after his admission. The polyuria and polydipsia improved in response to nasal inhalation of deamino-D-arginine vasopressin (DDAVP). We believe that the transient failure of insulin secretion and diabetic ketoacidosis were due to glucose toxicity caused by the excess glucose intake and severe dehydration that accompanied the water diuresis secondary to diabetes insipidus.
