“Is it normal for children to drink more water than adults?”
My son feels very thirsty throughout the day and drinks much more water than both me and my husband. Is there a problem or is it normal?
5 Answers
Yes, children have more active metabolisms than adults and need more fluids. In hot weather, it's recommended to use Pedialyte sports drink or Gatorade electrolyte solutions to prevent dehydration.
Water is the most essential element for all living things. The majority of human body is made up of water. Infants have 80% of their body composition as water. In children the body is made of 70% water. In adults men are made of 60% water and females are about 50% water. The human body have different water composition. The brain is 90% water. The bones are 22% made of water. The blood is 85% water, and the muscle is 75% water.
Water is not only important as a composition of human body but also maintains cellular structures, keep the fluidity of the blood, regulates body temperature (sweating), dissolves and eliminate metabolic byproducts, moisturizes and lubricates mucus membranes and joints, prevents constipation, and many other important body functions. That is why we require a lot of water.
Fluid requirements are usual based on body weight. Roughly a 10 Kg (22pounds) child will have a basic daily fluid requirement of 1 litter (one quart or 33 ounces (4 cups)). A 20 kg (45pounds) child will require at list 1.5 liters (one quart plus one pint or 50 ounces (6 cups)) of fluid a day. A 30 kg (66pound) child will have a minimum fluid requirement of 1.75 liters (one quart plus one and half pints or 60 ounces (7 cups)) per day. A 50 kg (110 pounds) child requires about 2.25 litters (2 quarts and a cup or about 9-10 cups (80 ounces)) a day. A 70 kg (150 pound) adult person will have a minimum fluid requirement of 3 litters ( 3 quarts or 12 cups) a day.
Infants and toddlers will have a higher fluid requirement since most of their food comes from milk or formula. Most children formula and whole milk are about 90% water. Therefore infants until 1 year require about 3-4 cups a day. Children until the age of three years require about 4-5 cups a day. At the age of 10 years most children are drinking about 6 cups of fluid. A child between the age of 15-18 years requires about 8-10 cups a day. Adult men have higher fluid requirement than adult women since women have more fat tissue than men and men have more muscle than women. Muscle is 75% water and fat is only 10% water. Since women have a little more fat than men and men have more muscle than women their fluid requirement is slightly different. This is also true for boys and girls. The adult man will require about 10- 12 cups of fluid a days while women generally require 8-10 cups a day.
The fluid requirement is greatly affected by temperature, humidity, degree and duration of physical activity, sweating, closing and etcetera. under this conditions fluid requirement will be much higher as fluid loss gets accelerated.
Normally fluids are lost through urine (mainly), feces, respiration from the lungs through the mouth and evaporation from the skin without sweating. However under condition that activate the sweat glands such as heat, humidity, intensive exercise or other work environments the fluid loss would be mainly through sweat gland in trying to cool the body. The sweat glans are therefore the air-conditioning of the body. Sometimes sweat loss can be more than 4 litters ( 4 quarts ) a day. Therefore fluid intake should increase during extensive physical activity, hot weather, humidity, diarrhea, vomiting, fever or other conditions that accelerate fluid loss from the body.
Fluid requirements are mainly met with water, with the exception of infants and young children who may still need milk and formula as their main source of food. Adults, older children and adolescents meet their fluid requirement from water, various drinks and foods. Most food have water in them. Even solid food contain about 15-25% water though none solid foods contain much higher water in them.
Under normal conditions in a temperate climate, most of the fluid loss is by the kidneys through urine. Under this condition the kidney contributed about two third of the total body fluid loss. The kidney is a filtration organ that removes most of the bodies waste products. The average adult kidney filters about 100 ml of blood per minute. At any given time 20% of the blood that gets to the kidneys filtration capsule gets filtered. In an hour the entire blood volume (5 quarts) gets filtered. In 24 hours (a day) the kidneys filter about 150 quarts/litters of blood. About 80% of the filtrate gets reabsorbed back to the body using simple osmotic gradient and another 10% gets absorbed using different pumps in the lumen. About 10% reaches the distal tubule and collecting duct before it becomes a concentrated urine. different hormone activate some of the pumps in the finale stage (distal tubule and collecting duct) to make the tubule and duct to be permeable to water so that the remaining 9% of the water will be reabsorbed. Finally, only about 1% or 1.5 quarts (6 cups) of the 150 quarts (600 cups) filtered in a day, in the kidneys is excreted in the urine. The final stages are important steps because they are controlled by hormones, mainly, antidiuretic hormone.
Thirsty is a physiologic mechanism of the body in the quest for water. The thirsty mechanism is housed in the hypothalamus of the brain. It is a mechanism to maintain internal body's homeostasis using hormones, neurons and behavioral factors. The thirsty mechanism in the hypothalamus is tightly controlled in response to change in blood tonicity or osmolality (275-295 mosm/kg). Change in blood osmolality or tonicity is the greatest stimulus of thirsty. Sodium level is the main determinant of plasma osmolality in this case. Changes in sodium level triggers change in osmolality (fluid movement between intracellular and extracellular spaces). Though change in volume (extracellular dehydration) is also a cause of a trigger in the thirsty mechanism, a bigger change in volume (10% volume change is required to stimulate thirsty) is required to achieve the same degree of thirsty compared to 1% change in serum osmolality. Once the thirsty mechanisms are activated either through osmotic dehydration or volume change the hypothalamus responds by releasing hormones vasopressin which acts on the kidney water permiabity to reabsorb more water and excrete less urine. Change in volume or osmolality activates the kidneys special cell (Juxtaglomerular apparatus) also respond by releasing hormones (renin) reabsorb more water from the filtration and increase the vascular tone to increase blood pressure. When renin is activated angiotensin and aldosterone (from the lungs and adrenal respectively) that help absorb more water and electrolyte (sodium) from the kidneys. Angiotensin also stimulates thirsty and increase vascular tone besides reabsorption of sodium and water in the kidneys.
Under normal conditions and in a temperate climate, the average person may need 2-3 litters (2-3 quarts) or 8-12 cups a day of fluid, either through various drinks, food or pure water. However when the temperature is hot and humid or when there is more physically demanding work environment or intensive physical activity, the fluid requirement may be more than double or triple. Children besides requiring the basic fluid intake, during intensive activity, hot and humid weather, fever, diarrhea and vomiting, will require double or triple fluid intake for their age and body weight.
Besides the basic physiologic cause of thirsty there are pathological conditions that trigger excessive thirsty or drinking. Such pathologic conditions are diabetes mellitus ( high sugar in the blood), hypercalcemia, and diabetes insipidus. These are hormonal conditions that are known to trigger excessive thirsty. Excessive thirsty is considered drinking more than three litters in adults in a temperate climate with out any other environmental factors or intensive physical activity or work environment or illnesses. Excessive drinking in children should be looked carefully. There should be careful consideration when children are suddenly drinking much more frequently (preferably water), or when they are excessive thirsty, bedwetting or waking up at night several times to go to washroom, or they are experiencing weight loss. These issues need to be addressed immediately by visiting their physician. Theses things could be signs of hormonal imbalance, such as diabetes insipidus, diabetes mellitus or hypercalcemia.
Diabetes millets is the most common metabolic disorder which affects 30 million Americans. Diabetes is mostly type 2 (90%) of cases. and less than 10% is type 1 diabetes, which is (insulin dependent or juvenile) an autoimmune disease. Though most of type 1 diabetes are adults most of childhood diabetes at list in the Caucasian population is type 1 diabetes.
the symptoms of diabetes are frequent urination, increased thirst (dehydration), hunger, blurred vision, fatigue, irritability, weight loss, bed wetting etcetera.
Simple urinalysis, blood sugar testing and HA1c would easily confirm the presence of most of diabetes mellitus. Differentiating type 1 diabetes mellitus versus type 2 should be done by performing pancreatic antibodies. Once the presence of diabetes mellitus is confirmed dietary, physical activity and or medications should be initiated as indicated.
Hypercalcemia is another cause of frequent drinking. Hypercalcemia can be caused by excess production of parathyroid hormone or other medical conditions. Excess parathyroid hormone can be due to isolated parathyroid adenoma on the neck or may be part of a bigger pathology call multiple endocrine neoplasia called MEN 1 and 2. Hypercalcemia can be diagnosed by checking serum and urine calcium, parathyroid hormone and 25 hydroxyvitamin D and 1,25 dihydroxy vitamin D. If both serum calcium and urine calcium are high a parathyroid scan is done to confirm the adenoma. Once adenoma is identified surgical removal is the next step. Of course there other causes and treatment modalities for hypercalcemia as well.
The next important cause of excessive thirsty and water intake is diabetes insipidus (tasteless diabetes as opposed to sweet diabetes due to high blood sugars). Diabetes insipidus is different from diabetes mellitus because it is tasteless and the blood sugars are normal. The hormone at the center of diabetes insipidus is antidiuretic hormone (vasopressin). This hormone is made in the (brain) hypothalamus and stored in the posterior pituitary gland and is released in response to thirsty and dehydration, to maintain normal cellular tonicity (osmolality). It mainly acts in the kidney's final filtration stage at the distal and collecting tubules. It renders the aquaporin in the kidney to become permeable to water so more water can be reabsorbed back to the body ( more concentrated urine) .
There are four forms of diabetes insipidus.
1) antidiuretic hormone deficiency or neurogenic diabetes insipidus or Central diabetes insipidus; In this pathology the body does not produce enough vasopressin (antidiuretic hormone) due to various reasons. When antidiuretic hormone is deficient, water reabsorption from the distal and collecting tubule is low. This hormone deficiency could be due to pituitary tumors, surgical removal of the pituitary gland, infections agent, bleedings, genetic defect in the pituitary gland or hypothalamus. These patients can loose many litters of water a day (up to 15 litters). Essentially the distal tubules and the collecting duct are less permeable to water reabsorption and the kidneys excrete large volume of dilute urine. A patient can urinate over 15 litters (quarts) a day. This causes dehydration. Because there is cellular dehydration the person is continuously thirsty and will drink excessive amount of water to compensate for the fluid loss through the urine. As long as the person has free access to water he/she will maintain normal electrolytes and may not get in trouble though it will affect and disrupt his/her life style because he /she will keep on drink frequently and urinates more frequently.
This is easily treated with ddavp (desmopressin). It can be given oral or via nasal spray.
2) Nephrogenic diabetes insipidus: This form of diabetes have similar symptoms to neurogenic diabetes insipidus. In this form of diabetes the body make more vasopressin hormone (antidiuretic hormone) but the kidneys do not respond to the hormone due to the defect in the kidney receptors of antidiuretic hormone either due to genetic defect or drug induced (mainly Lithium). The antidiuretic hormone fails to negotiate with the kidney vasopressin receptors to promote water permeability in the distal tubules and collecting duct. So the urine is very dilute and the patient loose a lot of water. Remember that 10% of the filtrates gets absorbed at this area of the nephron and the kidneys filter about 150 litters a day. Therefore 10% of 150 litters could be up to 15 litters a day lost in urine that could have been reabsorbed if the receptors were working fine. This fails to allow water permeability so that the remaining the 9% of the filtrate to be absorb back the from the distal tubule and collecting duct before the concentrate leaves as a urine. Treatment is amiloride and thiazide diuretics. Sometimes lithium therapy and other drugs can cause this type of diabetes insipidus. Removing lithium will solve the problem in some of these cases.
3) Psychogenic diabetes insipidus/ primary polydipsia: This form of diabetes is due to mostly habitual drinking. The patient drinks a lot of water with out hormonal deficiencies. It may be part of a bigger psychological problems such as anxiety obsessive compulsive behavior or schizophrenia. Dipsogenic diabetes insipidus could also be due to damage in the thirsty center of the brain. It can be treated with limiting fluid intake and psychological counseling.
4) Gestational diabetes insipidus: This is mainly in pregnancy and it resolves 4-6 weeks after delivery. The placenta makes a hormone that metabolizes (destroys) the vasopressin (antidiuretic hormone). The pregnant woman develops vasopressin deficient and develops all the symptoms of diabetes incipidus It is similar to central diabetes insipidus. And responds to ddavp.
The different hormonal cause of excessive drinking has be summarized above. They can be differentiated with blood glucose, calcium level and vasopressin level. The different forms of diabetes insipidus can be differentiated by taking the blood level of vasopressin, electrolytes, osmolality, and urine test. further evaluation can be done using water deprivation test and if necessary using vasopressin challenge in the case central diabetes insipidus.. These will differentiate 4 of the forms of diabetes insipidus. If central diabetes insipidus is confirmed MRI of the pituitary may be considered to rule out tumors or other anomalies of the pituitary gland or brain.
Going back to your son question: your son is drinking more than you and your husband. could this be normal?. It depends how old is he?. How much does he weigh?. How is his activity level?. Does he have any health issues or signs and symptoms?. When did all this start.? Does he prefer cold water or he drinks any thing.? How often does he go to the washroom.? Does he wake up at night to urinate?. Does wet the bed.? Is there any family history of diabetes?. Is there any weight loss?. Is there any recent change in his drinking habits?. Are there any complains such as headaches or visual changes?. When was the last time he saw his doctor?. Was his blood sugar ok.?. In the absence of these information it is hard to answer you question directly. If your son is an adolescent and he is active and is perfectly healthy then it is not an usual that he can drink much more than you or you husband.
Most children who are active above the age of 8 years old may drink 6 or more cups a day and adolescents can vary depending on their activity level. They can drink 10 or more cups a day depending on their situation..
However if there is a recent change in drinking behavior and if you have a good reason to be concerned, you should have him see his doctor for complete evaluation. Your gut feeling may be right as some of the above conditions may evolve slowly. Type 2 diabetes may take a long time to evolve. Diabetes insipidus may also take a long time to manifest as a full blown disease. On the other hand psychogenic or habitual drinking is seen in children with emotional issues.
It is a good idea to see his doctor and have him get a complete evaluation. Discuss these issues with his doctor and talk to him/her about his dinking habits in detail, current medications and any symptoms. He/she should be able to figure out the next best steps to determine if he has diabetes insipidus, diabetes mellitus or hypercalcemia or other conditions or he may be perfectly fine. Mostly it depends on the history of presentation. He may also refer you to a specialist if necessary and if indicated.
Good Luck.
Water is not only important as a composition of human body but also maintains cellular structures, keep the fluidity of the blood, regulates body temperature (sweating), dissolves and eliminate metabolic byproducts, moisturizes and lubricates mucus membranes and joints, prevents constipation, and many other important body functions. That is why we require a lot of water.
Fluid requirements are usual based on body weight. Roughly a 10 Kg (22pounds) child will have a basic daily fluid requirement of 1 litter (one quart or 33 ounces (4 cups)). A 20 kg (45pounds) child will require at list 1.5 liters (one quart plus one pint or 50 ounces (6 cups)) of fluid a day. A 30 kg (66pound) child will have a minimum fluid requirement of 1.75 liters (one quart plus one and half pints or 60 ounces (7 cups)) per day. A 50 kg (110 pounds) child requires about 2.25 litters (2 quarts and a cup or about 9-10 cups (80 ounces)) a day. A 70 kg (150 pound) adult person will have a minimum fluid requirement of 3 litters ( 3 quarts or 12 cups) a day.
Infants and toddlers will have a higher fluid requirement since most of their food comes from milk or formula. Most children formula and whole milk are about 90% water. Therefore infants until 1 year require about 3-4 cups a day. Children until the age of three years require about 4-5 cups a day. At the age of 10 years most children are drinking about 6 cups of fluid. A child between the age of 15-18 years requires about 8-10 cups a day. Adult men have higher fluid requirement than adult women since women have more fat tissue than men and men have more muscle than women. Muscle is 75% water and fat is only 10% water. Since women have a little more fat than men and men have more muscle than women their fluid requirement is slightly different. This is also true for boys and girls. The adult man will require about 10- 12 cups of fluid a days while women generally require 8-10 cups a day.
The fluid requirement is greatly affected by temperature, humidity, degree and duration of physical activity, sweating, closing and etcetera. under this conditions fluid requirement will be much higher as fluid loss gets accelerated.
Normally fluids are lost through urine (mainly), feces, respiration from the lungs through the mouth and evaporation from the skin without sweating. However under condition that activate the sweat glands such as heat, humidity, intensive exercise or other work environments the fluid loss would be mainly through sweat gland in trying to cool the body. The sweat glans are therefore the air-conditioning of the body. Sometimes sweat loss can be more than 4 litters ( 4 quarts ) a day. Therefore fluid intake should increase during extensive physical activity, hot weather, humidity, diarrhea, vomiting, fever or other conditions that accelerate fluid loss from the body.
Fluid requirements are mainly met with water, with the exception of infants and young children who may still need milk and formula as their main source of food. Adults, older children and adolescents meet their fluid requirement from water, various drinks and foods. Most food have water in them. Even solid food contain about 15-25% water though none solid foods contain much higher water in them.
Under normal conditions in a temperate climate, most of the fluid loss is by the kidneys through urine. Under this condition the kidney contributed about two third of the total body fluid loss. The kidney is a filtration organ that removes most of the bodies waste products. The average adult kidney filters about 100 ml of blood per minute. At any given time 20% of the blood that gets to the kidneys filtration capsule gets filtered. In an hour the entire blood volume (5 quarts) gets filtered. In 24 hours (a day) the kidneys filter about 150 quarts/litters of blood. About 80% of the filtrate gets reabsorbed back to the body using simple osmotic gradient and another 10% gets absorbed using different pumps in the lumen. About 10% reaches the distal tubule and collecting duct before it becomes a concentrated urine. different hormone activate some of the pumps in the finale stage (distal tubule and collecting duct) to make the tubule and duct to be permeable to water so that the remaining 9% of the water will be reabsorbed. Finally, only about 1% or 1.5 quarts (6 cups) of the 150 quarts (600 cups) filtered in a day, in the kidneys is excreted in the urine. The final stages are important steps because they are controlled by hormones, mainly, antidiuretic hormone.
Thirsty is a physiologic mechanism of the body in the quest for water. The thirsty mechanism is housed in the hypothalamus of the brain. It is a mechanism to maintain internal body's homeostasis using hormones, neurons and behavioral factors. The thirsty mechanism in the hypothalamus is tightly controlled in response to change in blood tonicity or osmolality (275-295 mosm/kg). Change in blood osmolality or tonicity is the greatest stimulus of thirsty. Sodium level is the main determinant of plasma osmolality in this case. Changes in sodium level triggers change in osmolality (fluid movement between intracellular and extracellular spaces). Though change in volume (extracellular dehydration) is also a cause of a trigger in the thirsty mechanism, a bigger change in volume (10% volume change is required to stimulate thirsty) is required to achieve the same degree of thirsty compared to 1% change in serum osmolality. Once the thirsty mechanisms are activated either through osmotic dehydration or volume change the hypothalamus responds by releasing hormones vasopressin which acts on the kidney water permiabity to reabsorb more water and excrete less urine. Change in volume or osmolality activates the kidneys special cell (Juxtaglomerular apparatus) also respond by releasing hormones (renin) reabsorb more water from the filtration and increase the vascular tone to increase blood pressure. When renin is activated angiotensin and aldosterone (from the lungs and adrenal respectively) that help absorb more water and electrolyte (sodium) from the kidneys. Angiotensin also stimulates thirsty and increase vascular tone besides reabsorption of sodium and water in the kidneys.
Under normal conditions and in a temperate climate, the average person may need 2-3 litters (2-3 quarts) or 8-12 cups a day of fluid, either through various drinks, food or pure water. However when the temperature is hot and humid or when there is more physically demanding work environment or intensive physical activity, the fluid requirement may be more than double or triple. Children besides requiring the basic fluid intake, during intensive activity, hot and humid weather, fever, diarrhea and vomiting, will require double or triple fluid intake for their age and body weight.
Besides the basic physiologic cause of thirsty there are pathological conditions that trigger excessive thirsty or drinking. Such pathologic conditions are diabetes mellitus ( high sugar in the blood), hypercalcemia, and diabetes insipidus. These are hormonal conditions that are known to trigger excessive thirsty. Excessive thirsty is considered drinking more than three litters in adults in a temperate climate with out any other environmental factors or intensive physical activity or work environment or illnesses. Excessive drinking in children should be looked carefully. There should be careful consideration when children are suddenly drinking much more frequently (preferably water), or when they are excessive thirsty, bedwetting or waking up at night several times to go to washroom, or they are experiencing weight loss. These issues need to be addressed immediately by visiting their physician. Theses things could be signs of hormonal imbalance, such as diabetes insipidus, diabetes mellitus or hypercalcemia.
Diabetes millets is the most common metabolic disorder which affects 30 million Americans. Diabetes is mostly type 2 (90%) of cases. and less than 10% is type 1 diabetes, which is (insulin dependent or juvenile) an autoimmune disease. Though most of type 1 diabetes are adults most of childhood diabetes at list in the Caucasian population is type 1 diabetes.
the symptoms of diabetes are frequent urination, increased thirst (dehydration), hunger, blurred vision, fatigue, irritability, weight loss, bed wetting etcetera.
Simple urinalysis, blood sugar testing and HA1c would easily confirm the presence of most of diabetes mellitus. Differentiating type 1 diabetes mellitus versus type 2 should be done by performing pancreatic antibodies. Once the presence of diabetes mellitus is confirmed dietary, physical activity and or medications should be initiated as indicated.
Hypercalcemia is another cause of frequent drinking. Hypercalcemia can be caused by excess production of parathyroid hormone or other medical conditions. Excess parathyroid hormone can be due to isolated parathyroid adenoma on the neck or may be part of a bigger pathology call multiple endocrine neoplasia called MEN 1 and 2. Hypercalcemia can be diagnosed by checking serum and urine calcium, parathyroid hormone and 25 hydroxyvitamin D and 1,25 dihydroxy vitamin D. If both serum calcium and urine calcium are high a parathyroid scan is done to confirm the adenoma. Once adenoma is identified surgical removal is the next step. Of course there other causes and treatment modalities for hypercalcemia as well.
The next important cause of excessive thirsty and water intake is diabetes insipidus (tasteless diabetes as opposed to sweet diabetes due to high blood sugars). Diabetes insipidus is different from diabetes mellitus because it is tasteless and the blood sugars are normal. The hormone at the center of diabetes insipidus is antidiuretic hormone (vasopressin). This hormone is made in the (brain) hypothalamus and stored in the posterior pituitary gland and is released in response to thirsty and dehydration, to maintain normal cellular tonicity (osmolality). It mainly acts in the kidney's final filtration stage at the distal and collecting tubules. It renders the aquaporin in the kidney to become permeable to water so more water can be reabsorbed back to the body ( more concentrated urine) .
There are four forms of diabetes insipidus.
1) antidiuretic hormone deficiency or neurogenic diabetes insipidus or Central diabetes insipidus; In this pathology the body does not produce enough vasopressin (antidiuretic hormone) due to various reasons. When antidiuretic hormone is deficient, water reabsorption from the distal and collecting tubule is low. This hormone deficiency could be due to pituitary tumors, surgical removal of the pituitary gland, infections agent, bleedings, genetic defect in the pituitary gland or hypothalamus. These patients can loose many litters of water a day (up to 15 litters). Essentially the distal tubules and the collecting duct are less permeable to water reabsorption and the kidneys excrete large volume of dilute urine. A patient can urinate over 15 litters (quarts) a day. This causes dehydration. Because there is cellular dehydration the person is continuously thirsty and will drink excessive amount of water to compensate for the fluid loss through the urine. As long as the person has free access to water he/she will maintain normal electrolytes and may not get in trouble though it will affect and disrupt his/her life style because he /she will keep on drink frequently and urinates more frequently.
This is easily treated with ddavp (desmopressin). It can be given oral or via nasal spray.
2) Nephrogenic diabetes insipidus: This form of diabetes have similar symptoms to neurogenic diabetes insipidus. In this form of diabetes the body make more vasopressin hormone (antidiuretic hormone) but the kidneys do not respond to the hormone due to the defect in the kidney receptors of antidiuretic hormone either due to genetic defect or drug induced (mainly Lithium). The antidiuretic hormone fails to negotiate with the kidney vasopressin receptors to promote water permeability in the distal tubules and collecting duct. So the urine is very dilute and the patient loose a lot of water. Remember that 10% of the filtrates gets absorbed at this area of the nephron and the kidneys filter about 150 litters a day. Therefore 10% of 150 litters could be up to 15 litters a day lost in urine that could have been reabsorbed if the receptors were working fine. This fails to allow water permeability so that the remaining the 9% of the filtrate to be absorb back the from the distal tubule and collecting duct before the concentrate leaves as a urine. Treatment is amiloride and thiazide diuretics. Sometimes lithium therapy and other drugs can cause this type of diabetes insipidus. Removing lithium will solve the problem in some of these cases.
3) Psychogenic diabetes insipidus/ primary polydipsia: This form of diabetes is due to mostly habitual drinking. The patient drinks a lot of water with out hormonal deficiencies. It may be part of a bigger psychological problems such as anxiety obsessive compulsive behavior or schizophrenia. Dipsogenic diabetes insipidus could also be due to damage in the thirsty center of the brain. It can be treated with limiting fluid intake and psychological counseling.
4) Gestational diabetes insipidus: This is mainly in pregnancy and it resolves 4-6 weeks after delivery. The placenta makes a hormone that metabolizes (destroys) the vasopressin (antidiuretic hormone). The pregnant woman develops vasopressin deficient and develops all the symptoms of diabetes incipidus It is similar to central diabetes insipidus. And responds to ddavp.
The different hormonal cause of excessive drinking has be summarized above. They can be differentiated with blood glucose, calcium level and vasopressin level. The different forms of diabetes insipidus can be differentiated by taking the blood level of vasopressin, electrolytes, osmolality, and urine test. further evaluation can be done using water deprivation test and if necessary using vasopressin challenge in the case central diabetes insipidus.. These will differentiate 4 of the forms of diabetes insipidus. If central diabetes insipidus is confirmed MRI of the pituitary may be considered to rule out tumors or other anomalies of the pituitary gland or brain.
Going back to your son question: your son is drinking more than you and your husband. could this be normal?. It depends how old is he?. How much does he weigh?. How is his activity level?. Does he have any health issues or signs and symptoms?. When did all this start.? Does he prefer cold water or he drinks any thing.? How often does he go to the washroom.? Does he wake up at night to urinate?. Does wet the bed.? Is there any family history of diabetes?. Is there any weight loss?. Is there any recent change in his drinking habits?. Are there any complains such as headaches or visual changes?. When was the last time he saw his doctor?. Was his blood sugar ok.?. In the absence of these information it is hard to answer you question directly. If your son is an adolescent and he is active and is perfectly healthy then it is not an usual that he can drink much more than you or you husband.
Most children who are active above the age of 8 years old may drink 6 or more cups a day and adolescents can vary depending on their activity level. They can drink 10 or more cups a day depending on their situation..
However if there is a recent change in drinking behavior and if you have a good reason to be concerned, you should have him see his doctor for complete evaluation. Your gut feeling may be right as some of the above conditions may evolve slowly. Type 2 diabetes may take a long time to evolve. Diabetes insipidus may also take a long time to manifest as a full blown disease. On the other hand psychogenic or habitual drinking is seen in children with emotional issues.
It is a good idea to see his doctor and have him get a complete evaluation. Discuss these issues with his doctor and talk to him/her about his dinking habits in detail, current medications and any symptoms. He/she should be able to figure out the next best steps to determine if he has diabetes insipidus, diabetes mellitus or hypercalcemia or other conditions or he may be perfectly fine. Mostly it depends on the history of presentation. He may also refer you to a specialist if necessary and if indicated.
Good Luck.
Stuart Jay Brink
Endocronologist (Pediatric)
Fluid intake is very variable from one individual to another and also depends upon exercise, outside temperatures, and saltiness of foods. With diabetes mellitus (sugar diabetes), the high sugar levels in the blood get processed by the kidneys and "pull out" water so there is more urination. The thirst is normal and responds to the loss of this extra fluid, so drinking too much and urinating too much (day or night including enuresis for little kids) becomes a symptoms of possible diabetes. There is also another kind of diabetes called DI, diabetes insipidus, and this reflects a problem with a pituitary hormone that also controls thirst and urination, but is not linked to blood sugar levels. Unexplained weight loss associated with increased urination and/or thirst also would be worrisome. Usually, kids do not drink more water than adults, so it would be helpful to have your child's doctor check a urine sample and perhaps consider some salt levels and sugar levels accordingly.
Stuart Brink, MD
Stuart Brink, MD
This could be normal, especially if your son is very active in sports. If he wakes up at night to drink, wets the bed, or gets up a lot at night to urinate, he could be showing signs of diabetes or an inability to concentrate his urine.
Increased thirst (polydipsia) could be a sign of diabetes mellitus or diabetes insipidus. He should be seen by an endocrinologist as soon as possible.
