I have a history of diabetes insipidus (DI) and my lab results show impaired renal concentration with a urine specific gravity below 1.05, accompanied by symptoms of extreme thirst, stomach pain, abdominal pain, hot arms, and cold hands and feet, could these symptoms be related to my condition and what is the difference between hyperthermia and hypothermia?

Your Symptoms Are Likely Related to Diabetes Insipidus and Dehydration

Your constellation of symptoms—extreme thirst, abdominal pain, hot arms, and cold hands/feet—strongly suggests volume depletion and electrolyte disturbances related to your diabetes insipidus, particularly if you've had inadequate fluid replacement or any interruption in your desmopressin therapy. 1

Understanding Your Current Situation

Why Your Symptoms Are Connected to DI

Your urine specific gravity below 1.05 (equivalent to osmolality <200 mOsm/kg) confirms that your kidneys are producing inappropriately dilute urine, which is the hallmark of diabetes insipidus 1, 2. This massive water loss through your urine creates a cascade of problems:

• Extreme thirst is your body's protective mechanism—your osmosensors detect rising serum sodium and trigger intense thirst to drive you to replace lost water 1
• Abdominal and stomach pain are classic signs of volume depletion and dehydration-associated electrolyte disorders 3
• Hot arms with cold hands and feet suggest peripheral vasoconstriction and altered circulation from hypovolemia (low blood volume), as your body tries to preserve blood flow to vital organs 3

Critical Immediate Actions Required

You need urgent medical evaluation today to check your serum sodium level. 1, 4 If your serum sodium is elevated (>145 mEq/L), you are experiencing hypernatremic dehydration, which can be life-threatening and lead to seizures, coma, or death if not corrected 5, 1.

Do the following immediately:

• Drink plain water continuously based on your thirst—do NOT restrict fluids 1, 4
• Avoid electrolyte drinks like Pedialyte or sports drinks, as these contain high sodium loads (1,035 mg/L) that will worsen hypernatremia in someone with DI who cannot concentrate urine 1
• Check if you've been taking your desmopressin as prescribed—any missed doses would explain your symptoms 6, 5
• Go to urgent care or emergency department for serum sodium measurement and possible IV fluid administration 4

Definitions: Hyperthermia vs. Hypothermia

Since you asked about these temperature-related conditions:

Hyperthermia

Hyperthermia is an abnormally elevated body core temperature (typically >40°C or 104°F) where the body produces or absorbs more heat than it can dissipate. 3 This includes:

• Heat stroke (the most severe form, associated with significant morbidity and mortality) 3
• Heat exhaustion 3
• Rebound hyperthermia (which worsens neurological outcomes in certain medical contexts) 3

Hypothermia

Hypothermia is an abnormally low body core temperature (typically <35°C or 95°F) where the body loses heat faster than it can produce it. 3 Physiological effects include:

• Shivering to increase metabolic heat production 3
• Bradycardia (slow heart rate) and arrhythmias 3
• Diuresis and electrolyte abnormalities including hypophosphatemia, hypokalemia, hypomagnesemia, and hypocalcemia 3
• Decreased insulin sensitivity causing hyperglycemia 3

Why Your "Hot Arms, Cold Hands and Feet" Don't Indicate True Hyperthermia or Hypothermia

Your symptoms of hot arms with cold extremities represent peripheral vasoconstriction from volume depletion, not true body temperature dysregulation 3. This is your body's attempt to maintain blood pressure by shunting blood away from your extremities to preserve vital organ perfusion 3.

Special Considerations for DI Patients

Fluid Management Pitfalls to Avoid

Never restrict water access—this is a life-threatening error in DI patients. 1, 4 You need:

• Free access to plain water 24/7 1, 4
• Fluid intake determined by your own thirst, not prescribed amounts, as your osmosensors are more accurate than any calculation 1
• Increased fluid intake by 0.5-1 L per day during hot weather or if experiencing increased losses 3

If You Require IV Fluids

If you need intravenous rehydration, you must receive 5% dextrose in water (D5W), NOT normal saline. 4 Normal saline delivers a high sodium load to kidneys that cannot concentrate urine, leading to severe hypernatremia 4. This is a critical distinction that emergency providers may not know about DI patients 4.

Medication Management During Illness

If you're experiencing volume depletion symptoms, your desmopressin dose may need adjustment 6, 5. However, serum sodium must be checked within 7 days and at 1 month after any dose change to prevent hyponatremia (dangerously low sodium), which can cause seizures, coma, or death 5, 6.

Bottom Line

Your symptoms are almost certainly related to your diabetes insipidus causing volume depletion. You need same-day medical evaluation with serum sodium measurement, continued free access to plain water, and possible adjustment of your desmopressin therapy 1, 4, 5. Do not delay seeking care, as severe hypernatremia can cause permanent neurological damage or death 1, 5.