By E. Feldman, R. Nelson
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Additional info for Canine and Feline Endocrinology and Reproduction
Phenobarbital), synthetic levothyroxine, and salt supplementation. Drug-induced polyuria and polydipsia do not usually pose a diagnostic challenge. The polyuria and polydipsia should resolve following discontinuation of the drug. If polyuria and polydipsia persist, a concurrent disorder causing polyuria and polydipsia or renal medullary solute washout should be considered. TABLE 1-5 DRUGS AND HORMONES CAUSING POLYURIA AND POLYDIPSIA IN DOGS AND CATS Anticonvulsants* Phenobarbital Primidone Dilantin Glucocorticoids* Diuretics* Mannitol Synthetic thyroid hormone supplements Amphotericin B Lithium Methoxyflurane Sodium bicarbonate Salt supplementation* Vitamin D (toxicity) * Common cause Renal medullary solute washout Loss of renal medullary solutes, most notably sodium and urea, results in loss of medullary hypertonicity and impaired ability of the nephron to concentrate the ultrafiltrate.
At plasma osmolalities below a certain minimum or threshold value (approximately 280 mOsm/kg), plasma vasopressin is uniformly suppressed to low or undetectable levels. Above this point, plasma vasopressin and the sensation of thirst increase in direct proportion to increases in plasma osmolality (Fig. 1-6). The relationship among thirst, plasma AVP concentration, and plasma osmolality is quite sophisticated. Increases of as little as 1% in plasma osmolality result in stimulation of water intake and vasopressin secretion (Hammer et al, 1980).
Remember that the concentration of the canine renal medullary interstitial fluid can be greater than 2500 mOsm/kg. (Reprinted with permission from Frohman LA, Krieger DT: In Felig P, et al (eds): Endocrinology and Metabolism. ) It should be noted that 85% to 90% of the fluid filtered by the glomerulus is reabsorbed isosmotically with sodium and glucose in the proximal portion of the nephron. Sodium is then selectively reabsorbed from the remaining fluid, making the fluid hypotonic as it reaches the distal nephron.