Does polyuria after spinal cord injury

imply relative diabetes insipidus state

S. J. Vadassery (1), A. Seneviratna (2), E. W. Ho (3), R. Dalan (4)
(1) Department of General Medicine, Tan Tock Seng Hospital (TTSH), Singapore
(2) Clinical Research and Innovation Office, TTSH
(3) Department of Rehabilitation Medicine, TTSH (4) Dept of Endocrinology, TTSH

What could cause polyuria in Polyuric patients trend towards

spinal cord injury (SCI)? reduced ADH variation / nocturia
• High incidence of polyuria and nocturia in
SCI leads to postural hypotension 
hampers effective rehab
• Diurnal variation in ADH release with higher
levels during sleep
• Fall in nocturnal urinary ADH excretion is
noted among patients with Parkinsonism
and autonomic dysfunction

Is night-time ADH (copeptin) lower in

SCI?
Is there loss of diurnal ADH variation in Higher urine volume trends
SCI?
Study design in TTSH Rehab towards lower night-time copeptin
Centre
Excluded:
TTSH Rehab Centre
SCI patients • Secondary causes:
heart failure, liver
cirrhosis, kidney
disease
• Diuretics or lithium
30 SCI patients • Solute diuresis:
enrolled from March hyperglycaemia,
2017 to March 2018 hypercalcaemia, and
hyperthyroidism

20 controls without
polyuria
Polyuria
= urine output ≥ Polyuria likely related to
3L/day 10 cases with
or >40mls/Kg/day polyuria autonomic dysfunction, impaired
ADH release
Higher / more severe injury Possible mechanisms:
trends towards polyuria • excessive release of ADH while up and
about  inhibited while they are recumbent
No Polyuria Polyuria P-value at night
C5 and above 1 (6.67) 2 (28.57) 0.227 • relative fluctuation in blood volume with
ASIA A+B (%) upright posture and recumbency  loss of
C5 and above 14 (93.33) 5 (71.43)
diurnal variation in carotid baroreceptor-
ASIA C+D (%)
mediated ADH release from the
T6 and above 1 (6.67) 4 (40.00) 0.121
hypothalamus Thanks to
ASIA A+B (%)
T6 and above 14 (93.33) 6 (60.00) • Dr Adela Tow, Spinal Cord Injury, Rehabilitation
ASIA C+D (%) Medicine, TTSH