Clinical examination may provide important clues to possible underlying diagnoses. The age at which symptoms develop together with the pattern of fluid intake, may influence subsequent investigation of diabetes insipidus. The primary symptoms are persistent polyuria and polydipsia, and young children may have severe dehydration, vomiting, constipation, fever, irritability, sleep disturbance, failure to thrive and growth retardation.

It is important to ask questions about the onset and presentation of symptoms. Some of the useful information to obtain in the history of DI include:^[1]

• Polyuria
• Polydipsia
• Nocturia
• Family history

Symptoms of diabetes insipidus are quite similar to those of untreated diabetes mellitus, with the distinction that the urine is not sweet as it does not contain glucose and there is no hyperglycemia (elevated blood glucose):

• Excessive urination and extreme thirst (especially for cold water)
• Blurry vision
• Extreme urination that continues throughout the day and the night

In children, DI can interfere with appetite, eating, weight gain, and growth as well. They may present with:^[2]

• Fever
• Vomiting
• Diarrhe

Adults with untreated DI may remain healthy for decades as long as enough water is drunk to offset the urinary losses. However, there is a continuous risk of dehydration.

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