Differential Diagnosis for Polyuria
The patient presents with polyuria and nocturia after a recent reduction in Lantus dosage and initiation of Hiprex. The following differential diagnoses are considered:
- Single most likely diagnosis
- Improved glycemic control: The reduction in Lantus dosage and the patient's high time in range (80%) as per Dexcom CGM may indicate improved glycemic control, which can lead to increased glucose excretion in the urine, causing polyuria.
- Other Likely diagnoses
- Diuretic effect of Hiprex: Hiprex (methenamine hippurate) can have a mild diuretic effect, which may contribute to polyuria.
- Increased fluid intake: The patient may be drinking more fluids due to the recent initiation of Hiprex, which can increase urine production.
- Trulicity (dulaglutide) side effect: Trulicity can cause increased urine production as a side effect, although this is less common.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Diabetic ketoacidosis (DKA): Although the patient's time in range is high, any significant change in glycemic control or medication can increase the risk of DKA, which can present with polyuria.
- Urinary tract infection (UTI): Despite the absence of stinging or burning, a UTI cannot be completely ruled out, especially given the patient's history of UTIs.
- Kidney disease or nephropathy: Uncontrolled diabetes can lead to kidney damage, which may cause polyuria.
- Rare diagnoses
- Primary polydipsia: A rare condition characterized by excessive thirst and fluid intake, leading to polyuria.
- Nephrogenic diabetes insipidus: A rare condition where the kidneys are unable to respond to antidiuretic hormone (ADH), leading to polyuria.
- Central diabetes insipidus: A rare condition where the pituitary gland does not produce enough ADH, leading to polyuria.