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Functional: Nocturia
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== Diagnosis and Evaluation == === UrologySchool.com Summary (2): === #'''<span style="color:#ff0000">History and Physical Exam</span>''' #'''<span style="color:#ff0000">Voiding diary/frequency-volume chart</span>''' === History and Physical Exam === ==== History ==== * '''Nocturia be a symptom of serious systemic illnesses including hypertension, diabetes, heart disease, and kidney disease''' * '''<span style="color:#ff0000">Drug effects causing nocturia</span>''' ** '''<span style="color:#ff0000">Increased urine output (5):</span>''' **# '''SSRIs''' (block antidiuretic hormone secretion) **# '''Tetracycline''' (attenuates antidiuretic hormone via decreases in cAMP accumulation and action) **# '''Calcium channel blockers''' (increases atrial natriuretic peptide, blocks sodium reabsorption in proximal convoluted tubule) **# '''Lithium (drug-induced nephrogenic diabetes insipidus)''' **# '''Diuretics: timing of diuretic administration should be mid-afternoon''', to allow for elimination of lower extremity excess body fluid during normal waking hours. Men with nocturnal polyuria may benefit from diuretic therapy 6 hours before sleep ** '''<span style="color:#ff0000">Insomnia and CNS effects</span>''' *** '''CNS stimulants''': dextroamphetamine, methylphenidate *** '''Antihypertensives''': Ξ±-Blockers, Ξ²-Blockers, methyldopa *** '''Respiratory''': albuterol, theophylline *** '''Decongestants''': phenylephrine, pseudoephedrine *** '''Hormones:''' corticosteroids, thyroid *** '''Psychotropics''': MAOIs, SSRIs, atypical antidepressants *** '''Dopaminergic''' '''agonists:''' carbidopa *** '''Antiepileptics:''' phenytoin ** '''<span style="color:#ff0000">Direct lower urinary tract effects</span>''' *** '''Ketamine''': direct bladder toxin *** Tiaprofenic acid (Surgam): toxic cystitis *** Cyclophosphamide ==== Physical exam ==== * '''<span style="color:#ff0000">Peripheral edema</span>''' resulting from cardiac disease, nephrotic syndrome, venous insufficiency * '''<span style="color:#ff0000">Obesity and short neck may be suggestive of obstructive sleep apnea</span>''' and be associated with nocturnal polyuria === Voiding Diary/Frequency-volume chart === * '''<span style="color:#ff0000">Most useful tool in evaluating and classifying the cause of nocturia</span>'''
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