Polyuria

Polyuria
ICD-10	R35.
ICD-9	788.42

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Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753;

Overview

Polyuria is the passage of a large volume of urine in a given period (>= 2.5L/24 hours in adult humans) [2] It often appears with increased thrist (polydipsia), though it is possible to have one without the other.

Causes

"Urinary frequency" is a symptom often experienced by patients struggling with a variety of bladder conditions such as interstitial cystitis, overactive bladder, radiation cystitis, chemotherapy- induced cystitis, urinary tract infection (UTI) and eosinophilic cystitis. In these cases, patients may urinate up to 60 times a day and struggle with sleeplessness due to nocturia, frequent urination at night. Urinary frequency often occurs in patients with wounds and/or inflammation of the urothelium (aka the bladder wall) due, in part, to an activation of the alpha adrenergic nerves. Diet is a common trigger, particularly foods high in acid and/or caffeine including coffees, regular teas, green teas, sodas, diet sodas and fruit juices. Cranberry juice, for example, is devastating to most interstitial cystitis patients due to its high acid content. Patients with bladder conditions have a variety of medical therapies available and should consult with their physicians directly to help determine the cause of their urinary frequency.

The use of diuretics may contribute to urinary frequency and/or polyuria, such as: Coffee, Cranberry Juice, and Alcohol. Other potential but as yet unconfirmed associations include anti-caking compounds added by commercial food processing companies to table salt and to fine powders such as sucrose and fillers for medications and supplements. Two of these compounds are silica (silicon dioxide) and yellow prussiate of soda (sodium ferrocyanide). Approximately three hours after ingestion of these compounds some individuals, primarily those over age 50 will experience polyuria for an additional ten hours. Individuals can demonstrate this relationship by water fasting for 24 hours (augmented only by fresh unprocessed, well rinsed and unseasoned foods like meat, vegetables and large fruit). Because medications are a significant source of anti-caking compounds, this water fast should not be attempted by those who can not also abstain from taking any pills or capsules during the fast. Some berries and grains are sprayed with anti-caking compounds to slow moisture damage. Poorly rinsed glasses or dishes are also suspected sources due to substantial use of these compounds in some liquid detergents. Symptoms should disappear or substantially diminish ten to twelve hours after beginning the fast and reappear three hours after ingesting any food or medication containing these compounds. Research is needed to more thoroughly explore the relationship of these compounds to polyuria.

• An antidiuretic would in turn decrease urine flow. (See Vasopressin)

Differential Diagnosis of Polyuria

In alphabetical order.

• Acromegaly
• Addison's disease
• Alcohol
• Behavioral or psychogenic water drinking
• Caffeine
• Chemotherapeutic agents
• Congestive heart failure
• Cushing's syndrome
• Cystitis
• Diabetes insipidus
• Diabetes mellitus
• Diuretics
• Emphysematous cystitis
• Enlarged prostate from disease or benign prostatic hyperplasia
• Fanconi syndrome/renal glycosuria
• Glomerulonephritis
• high doses of riboflavin
• Hyperaldosteronism/Conn's syndrome
• Hypercalcaemia
• Hypercalcemia (most commonly from cancer)
• Hyperthyroidism
• Hypokalemia
• hypopituitarism
• Interstitial cystitis
• Interstitial nephritis
• Intestinal obstruction (occurs after toxins begin to be absorbed from the damaged intestine)
• Liver failure/ cirrhosis
• Lupus or other connective tissue disease related cystitis
• Neurologic damage
• Partial obstruction of the urinary tract
• Pheochromocytoma
• Polycythemia
• Pregnancy
• Pyometra in certain animals or appendicitis in humans
• Reactive arthritis/Reiter's syndrome
• Renal Tubular Acidosis
• SIADH
• Side effect of lithium to treat manic disorders see lithium thirst
• Sjogren's Syndrome
• Squamous cell carcinoma of lung (a paraneoplastic consequence)
• Urinary tract infection - although it more commonly causes frequent passage of small volumes of urine rather than a large volume