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Medical Forum / General / General / October 2006Polyuria with unusual pattern
I am a 58 year old male with polyuria that varies during the course of a week. I work full time Monday to Friday. I do not experience excessive or frequent urination during the day. My flow is full, no stops and starts. Here is my nightly urine output for the week: Monday--half pint--wake up 2 and 4 hours after going to sleep with full, bursting bladder. Tuesday--1.5 pints--wake up 2 and 4 and hours after going to sleep with full, bursting bladder. Wednesday to Friday--1 to 2 quarts--wake up 1, 2, 4, 6 hours after going to sleep with full, bursting bladder. Saturday--pint to 1.5 pints--wake up 2 and 4 and hours after going to sleep with full, bursting bladder. Sunday--less than half pint--no urgency--could sleep the night if I chose, but usually get up once 4-5 hours after going to bed--output insignificant. Sunday night is the only night I feel normal. This routine is the same on or off caffeine, it has no effect. Two years ago I quit caffeine for a month to test the pattern and it was unchanged. Blood and urine tests including the 5 hour diabetes test were negative, except I do tend to go a little low on potassium so I take a supplement. My urologist says my legs drain of water durung sleep but that doesn't explain the fluctuations. If someone has the answer to this, please tell me. Thank you. It's the taste of normalcy on Sunday that's driving me insane. > I am a 58 year old male with polyuria that varies during the course of > a week. I work full time Monday to Friday. I do not experience [quoted text clipped - 31 lines] > If someone has the answer to this, please tell me. Thank you. It's the > taste of normalcy on Sunday that's driving me insane. Urine formation actually decreases during sleep. One has a decreased blood pressure and thus the urine is actually more concentrated in the morning upon awaking. Most tests concerning urine actually prefer the first morning specimen because of this including pregnancy testing etc. The obvious question is do you have trouble emptying your bladder and drinking excess amount of water before bedtime? Your urologist has probably done testing to check for the usual culprits and came up with nothing as thus the explanation he came up with as being a normal physiological process. Neurogenic polydipsia is pretty common. It is the most common cases the endocrinologist or urologists will come across when evaluating polyuria. rindsight@netscape.net wrote: > I am a 58 year old male with polyuria that varies during the course of > a week. I work full time Monday to Friday. I do not experience [quoted text clipped - 31 lines] > If someone has the answer to this, please tell me. Thank you. It's the > taste of normalcy on Sunday that's driving me insane. Urine formation actually decreases during sleep. One has a decreased blood pressure and thus the urine is actually more concentrated in the morning upon awaking. Most tests concerning urine actually prefer the first morning specimen because of this including pregnancy testing etc. The obvious question is do you have trouble emptying your bladder and drinking excess amount of water before bedtime? Your urologist has probably done testing to check for the usual culprits and came up with nothing as thus the explanation he came up with as being a normal physiological process. Neurogenic polydipsia is pretty common. It is the most common cases the endocrinologist or urologists will come across when evaluating polyuria. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Robert, Could adrenal problems cause the symptoms mentioned in the post? Could the present or absence of ADH be the cause of those symptoms? Jason ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ >> I am a 58 year old male with polyuria that varies during the course of >> a week. I work full time Monday to Friday. I do not experience [quoted text clipped - 36 lines] > morning upon awaking. Most tests concerning urine actually prefer the > first morning specimen because of this including pregnancy testing etc. I doubt he is pregant. ;-) In addition, there is a compound that the brain makes during sleep called anti-diuretic hormone. This hormone also decreases the amount of urine made for a period of time. > The obvious question is do you have trouble emptying your bladder and > drinking excess amount of water before bedtime? Your urologist has [quoted text clipped - 3 lines] > the most common cases the endocrinologist or urologists will come > across when evaluating polyuria. The differences in urine volume might be explained by differences in activity levels. Increased activity or different activity might help keep his legs free of excess water. But it takes until Sunday for the full effect to be felt.' Jeff > >> I am a 58 year old male with polyuria that varies during the course of > >> a week. I work full time Monday to Friday. I do not experience [quoted text clipped - 38 lines] > > I doubt he is pregant. ;-) No, LOL. I see that question a lot about urine pregnancy tests. Actually the same applies to other urine tests such as chlamydia and other antigens, Legionella, TB, etc. Early morning urines are more concentrated. The reason I have seen is in regard to a decrease production is the decrease in BP 10/5 mm Hg. Without me looking into it any further, diurnal hormonal changes also come into play. What I didn't see mentioned in recent memory is a loss of diurnal variation is possible with ADH resulting in regular diuresis. One learns something new every day or maybe relearns something old. Can't remember now. > In addition, there is a compound that the brain makes during sleep called > anti-diuretic hormone. This hormone also decreases the amount of urine made > for a period of time. I just saw an old reference to a lack of such diurnal variation resulting in diuresis in the elderly at night. J Intern Med. 1991 Feb;229(2):131-4. Related Articles, Links Diurnal variation in the levels of antidiuretic hormone in the elderly. PMID: 1997638 My guess is it's mostly a nuisance and not pathological as people would just drink more water during the day time to replace the water lost at night. It is seen often in the "healthy" elderly. In 25% of those healthy, no detectable ADH at all at night. I don't know if 58 years old qualifies as elderly. There is some reference to such a loss of diurnal variation with regard to spinal cord injury and significant nocturnal polyuria causing problems in bladder overdistention. ADH was used in such cases. > > The obvious question is do you have trouble emptying your bladder and > > drinking excess amount of water before bedtime? Your urologist has [quoted text clipped - 10 lines] > > Jeff Wouldn't that be more associated with edematous states and water retention in dependent areas? One would think this as a normal aspect in everyone and only significant when other abnormalities are present. In any case one would simply do blood chemistries and urine chemistries at night and day to evalute and determine the nature of the diuresis.Pretty easy to do. Don't know if that was done or not or such changes were attributed to interstitial to vascular compartment shifts. I guess it's nice to know as we end up all old-geezers getting up and peeing at night. |
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