Makewai mau, mimi mau? ʻO Central Diabetes Insipidus (CDI) anei kēia? E kamaʻilio kākou!

Ke ʻike nei hoʻi ʻoe i ka maʻi kahe wai i ke ao holoʻokoʻa? ʻAʻohe mea nui ka nui o ka wai āu e inu ai, ʻaʻole ia e hana? Pono nō hoʻi ʻoe e ala pinepine, i kekahi manawa i ka pō, e mimi? ʻOiai ke hana ʻoe, nui anei kou mimi wai māmā? A laila he mea nui paha kēia iā ʻoe. Kāhea mākou i kēia maʻi ʻo Central Diabetes Insipidus, a i ʻole 'Central Diabetes Insipidus (CDI)'. ʻOiai he "diabetes" kona inoa, ʻaʻole kēia ka maʻi diabetes mellitus a mākou e ʻike nei. E kamaʻilio kākou e pili ana i kēia me nā kikoʻī.

He aha ka Central Diabetes Insipidus (CDI)?

I ka ʻōlelo maʻalahi, he maʻi laha ʻole ka 'Central Diabetes Insipidus (CDI). ʻO ka mea e hana ʻia ana, ʻaʻole lawa ka Antidiuretic Hormone (ADH) i kou kino, i kapa ʻia ʻo Vasopressin i kekahi manawa. Kōkua kēia hormone ADH i ka hoʻomalu ʻana i ka nui o ka wai i loko o ko kākou kino. Ke haʻahaʻa kēia hormone, hoʻomaka nā puʻupaʻa e hoʻokuʻu i ka wai hou aku ma ke ʻano he mimi. No laila, mimi nui ʻoe a manaʻo ʻoe ua pehu loa.

Hoʻopuka ʻia kēia hormone ADH e ka hypothalamus i loko o ko kākou lolo. Eia nō naʻe, mālama ʻia a hūnā ʻia i ka wā e pono ai e kahi gland liʻiliʻi ʻē aʻe i loko o ka lolo , ʻo ia hoʻi ka pituitary gland . No laila, inā he pōʻino i ka hypothalamus a i ʻole ka pituitary gland, hiki ke ulu ka CDI.

Inā loaʻa iā ʻoe ka CDI, inā ʻaʻole ʻoe e inu i ka wai lawa e pani i ka nui o ka wai āu e nalowale ai ma o ka mimi, hiki iā ʻoe ke maloʻo loa . He mea weliweli maoli kēia.

Loaʻa paha i kekahi poʻe kahi ʻano CDI ʻoi aku ka koʻikoʻi, ʻo ia hoʻi, ʻaʻole hana pono ka hormone ADH. Ua kapa ʻia kēia he 'CDI piha'. Loaʻa paha i kekahi ke ʻano palupalu, ʻo ia hoʻi, ke hana nei ka hormone ADH i kekahi ʻano. Ua kapa ʻia kēia he 'CDI hapa'.

ʻO ka mea nui loa, ke lohe ʻoe i ka inoa ʻo 'Diabetes Insipidus', mai huikau me 'Diabetes Mellitus'. Loaʻa i kēia mau maʻi ʻelua ka huaʻōlelo 'diabetes' no ka mea, ua like nā hōʻailona o kēia mau maʻi ʻelua o ka makewai nui a me ka mimi pinepine. Loaʻa ka huaʻōlelo 'diabetes' mai ka huaʻōlelo Helene ʻo 'diabainein'. ʻO ia hoʻi 'e hele ma waena'. E like me ka wai e hele wikiwiki ana ma ke kino a hoʻokuʻu ʻia ma ke ʻano he mimi.

ʻEhā ʻano nui o ka `Diabetes Insipidus`:

• ʻO ka 'Central Diabetes Insipidus (CDI)' - ʻO kēia ke ʻano maʻamau a mākou e kamaʻilio nei.
• Nephrogenic Diabetes Insipidus - ʻAʻole pane nā puʻupaʻa i ka ADH.
• ʻO ka maʻi diabetes insipidus dipsogenic ma muli o ka makemake nui e inu i ka wai nui.
• ʻO ka maʻi diabetes insipidus gestational he maʻi ia no ka manawa pōkole e kū mai ana i ka wā hāpai.

He aha kēia ADH (hormone antidiuretic)?

ʻO ADH, a i ʻole vasopressin, e like me ka mea i ʻōlelo ʻia ma mua, he hormone i hana ʻia e kou hypothalamus a mālama ʻia a hoʻokuʻu ʻia e kāu pituitary gland.Ua like lākou me nā ʻelele kemika e hoʻonohonoho i nā hana like ʻole o ko mākou kino. Hele kēia mau mea ma o ke koko a lawe i nā leka i ko mākou mau ʻōpū, nā ʻiʻo, a me nā ʻiʻo ʻē aʻe. Hōʻike kēia mau hōʻailona i ke kino i ka mea e hana ai a me ka manawa e hana ai.

ʻO ka hypothalamus ka ʻāpana o ko kākou lolo e kaohi ana i ka hana o ka ʻōnaehana nerve autonomic a me ka pituitary gland. Hana ia i ka ADH a hoʻouna iā ia i ka pituitary gland e mālama a hoʻokuʻu i ka wā e pono ai.

He ʻāpana liʻiliʻi ka pituitary gland ma ke kumu o ka lolo, ma lalo pono o ka hypothalamus. He ʻāpana ia o kā mākou ʻōnaehana endocrine. ʻO kāna hana ka hana, mālama, a hoʻokuʻu i nā hormones koʻikoʻi he nui. Mālama ʻia a hoʻokuʻu ʻia ʻo ADH e ka posterior pituitary gland.

ʻO ka ADH ka mea nui e hoʻomalu i ka nui o ka wai e komo hou ai ko kākou mau puʻupaʻa i loko o ko kākou kino ke kānana lākou i nā huahana ʻōpala mai ko kākou koko, no laila e mālama ana i ke kaulike wai i loko o ke kino. ʻO ka maʻamau, ke maloʻo ʻoe a i ʻole haʻahaʻa kou koko, hana a hoʻokuʻu kou kino i ka ADH hou aku. Hōʻailona kēia i nā puʻupaʻa e "mālama i ka wai i loko o kou kino, ʻaʻole e hoʻokuʻu iā ia i loko o ka mimi."

No laila, ma CDI, ʻaʻole hana ka hypothalamus i ka ADH lawa, a ʻaʻole hoʻokuʻu ka pituitary gland i ka ADH lawa. ʻO ia ke kumu e nui pinepine ai ka mimi.

He aha ka ʻokoʻa ma waena o ka Central Diabetes Insipidus (CDI) a me ka Nephrogenic Diabetes Insipidus?

Ua like nā hōʻailona o nā maʻi ʻelua: ka mimi nui ʻana a me ka inu nui ʻana i ka wai. Aia ka ʻokoʻa ma ke kumu a me ka mālama ʻana i kēia mau maʻi ʻelua.

ʻO ka Nephrogenic Diabetes Insipidus ke hoʻokuʻu ʻia ka nui o ka ADH e kou kelepa pituitary, akā ʻaʻole pane pono kou mau puʻupaʻa. ʻO ia hoʻi, ʻaʻole hiki i kou mau puʻupaʻa ke mālama i ka wai. Aia kekahi mau kumu no kēia:

• ʻO kekahi mau lāʻau lapaʻau, no ka laʻana , lithium a me tetracycline .
• Ka haʻahaʻa o ka potassium i loko o ke koko (Hypokalemia) .
• Hoʻonui ʻia ka nui o ka calcium i loko o ke koko (Hypercalcemia) .
• Ka ālai ʻana o ke ala mimi.

Hoʻokumu ʻia ka Central Diabetes Insipidus (CDI) e kahi hana hewa o ka hypothalamus a i ʻole ka pituitary gland, ka mea i hana ʻole i ka ADH lawa. ʻO ka maʻamau, hoʻokumu ʻia ia e ka hōʻino ʻana i ka hypothalamus a i ʻole ka pituitary gland. Hiki ke hana ʻia kēia hōʻino e nā mea e like me nā ʻeha poʻo, ke ʻoki kino, ka mumū, a i ʻole nā ​​​​​​pūpū.

ʻO wai ka mea e loaʻa ana i ka CDI? Pehea ka maʻamau?

Hiki ke ulu ka Central Diabetes Insipidus (CDI) i kēlā me kēia makahiki, akā ʻoi aku ka maʻamau o ka hoʻomaka ʻana ma waena o nā makahiki 10 a me 20 .

He maʻi laha ʻole ka CDI, hoʻokahi wale nō i loko o 25,000 mau kānaka e hoʻopilikia nei.

He aha nā hōʻailona o ka CDI?

ʻO nā hōʻailona nui o ka 'Central Diabetes Insipidus (CDI)' penei:

• Ka mimi pinepine ʻana, ʻoiai i ka pō.
• Ka hoʻokahe ʻana i ka nui o ka mimi māmā a moakāka paha i kēlā me kēia manawa.
• Manaʻo nui i ka luhi a me ka make wai , no laila e inu pinepine i nā wai.

ʻOiai ke hoʻokuʻu nei ke kanaka maʻamau i hoʻokahi a ʻelua lita o ka mimi i kēlā me kēia lā, hiki i kekahi me CDI ke hoʻokuʻu a hiki i 19 lita (20 kuata) o ka mimi i kēlā me kēia lā ! E noʻonoʻo i ka nui o ia mea!

Nā hōʻailona i nā pēpē ʻōpio

Hiki i nā pēpē me CDI ke hōʻike i nā hōʻailona e like me kēia:

• Hoʻomaha mau a me ka huhū.
• Ka palaualelo.
• Ka luaʻi ʻana.
• Ka paʻa ʻana o ka ʻōpū.
• Kuni.

Nā hōʻailona o ka make wai

Inā waiho ʻole ʻia ka CDI me ka mālama ʻole ʻia, a inā ʻaʻole inu ka mea me CDI i ka wai lawa, hiki koke ke make ka wai . ʻO nā hōʻailona o ka make wai:

• Pōʻino, manaʻo māmā ke poʻo.
• Luhi.
• Waha maloʻo, lehelehe, maka.
• Ka paʻakikī e hana i nā hana noʻonoʻo maʻalahi.
• Ka luaʻi.
• Ka mae ʻana.

Inā makewai nui ʻoe a mimi pinepine a/a i ʻole nā ​​hōʻailona o ka make wai, he mea nui loa e hele koke i ka haukapila. ʻOiai he mea kakaikahi ka CDI, ʻaʻole ia wale nō ke kūlana e hiki ai ke hana i kēia mau hōʻailona. ʻO ka makewai nui a me ka mimi pinepine he mau hōʻailona ikaika ia e hana pono ʻole ana kekahi mea i loko o kou kino a pono ʻoe i ke kōkua lapaʻau.

He aha nā kumu o ka Central Diabetes Insipidus (CDI)?

ʻO ke kumu nui o ka Central Diabetes Insipidus (CDI) he nele piha a hapa paha o ka hormone ADH. ʻO ka maʻamau, hana ʻia kēia hemahema e ka hōʻino ʻana i kou hypothalamus, ka pituitary gland, a i ʻole ke kino e hoʻopili ai i nā mea ʻelua (pituitary stalk). ʻO kekahi mau kumu kikoʻī:

• Ka hōʻino ʻia ʻana o ka hypothalamus a i ʻole ka pituitary gland ma muli o ke ʻoki kino.
• Ka hōʻino ʻia ʻana o ka hypothalamus a i ʻole ka pituitary gland ma muli o ka ʻeha o ke poʻo, ʻoiai hoʻi nā haki poʻo kumu.
• ʻO ka mumū (granulomas) i hoʻokumu ʻia e nā maʻi e like me ka sarcoidosis a i ʻole ka maʻi puʻupuʻu .
• ʻO nā puʻupuʻu e like me ka craniopharyngioma a i ʻole germinoma .
• ʻO ka histiocytosis cell Langerhans (he maʻi laha ʻole kēia e hiki ai ke hōʻino i nā ʻiʻo a i ʻole ka ʻeha ma kekahi a ʻoi aku paha o nā wahi o ke kino).
• He hoʻololi hoʻoilina i hoʻoilina ʻia ma ka chromosome 20 (he mea kākaʻikahi loa kēia - ʻaʻole i hōʻike ʻia ma mua o 100 mau hihia ma nā palapala lapaʻau).

Ma kahi o ka hapakolu o nā hihia CDI, ʻaʻole hiki i nā kauka ke loaʻa ke kumu pololei. Ua kapa ʻia kēia he idiopathic central diabetes insipidus (CDI).Manaʻo nā kānaka noiʻi ua hiki ke hana ʻia kekahi mau hihia o ka idiopathic CDI e nā kumu autoimmune. I nā kūlana autoimmune, hoʻomaka ka ʻōnaehana pale o kou kino e hoʻouka i nā ʻiʻo olakino. I kēia hihia, hiki i ka ʻōnaehana pale ke hana i nā antibodies, a i ʻole lymphocytes, e hoʻouka i nā cell e hana ana iā ADH.

Hiki i ka CDI ke hana ma ke ʻano he ʻāpana o kahi maʻi nui a i ʻole ke ʻano, e like me ka Wolfram syndrome ( kahi ʻano hoʻoilina) a me ka septo-optic dysplasia (kahi maʻi laha ʻole o ka ulu mua ʻana o ka lolo).

Pehea ʻoe e ʻike ai inā loaʻa iā ʻoe ka CDI? (Diagnosis)

Ma muli o ka makewai pinepine a me ka mimi ʻana hiki ke hana ʻia e nā kūlana ʻē aʻe, e like me ka maʻi diabetes mellitus, he mea nui e kāpae i nā kūlana ʻē aʻe i ka wā e ʻike ai i ka maʻi diabetes insipidus waena (CDI). No laila, inā loaʻa iā ʻoe kēia mau hōʻailona, ​​​​hiki i kāu kauka ke hana i kekahi mau hoʻokolohua.

ʻO ka ʻike ʻana i ka CDI e komo pū ana me ka ʻike ʻana i ke kumu.

He aha nā hoʻokolohua i hoʻohana ʻia e ʻike ai i ka CDI?

ʻO ka hoʻāʻo hoʻonele wai ke ala maʻalahi a hilinaʻi hoʻi e ʻike ai i ka CDI. Inā kauoha kāu kauka i kēia hoʻāʻo, e hōʻoia lākou e nānā pono ʻia ʻoe i ka wā o ka hoʻāʻo ʻana, no ka mea hiki ke hoʻoheheʻe ʻia.

ʻO kēia hoʻāʻo e pili ana i ka hele ʻole ʻana me ka wai ʻole no kekahi mau hola a ʻike i ke ʻano o ka pane ʻana o kou kino. Inā loaʻa iā ʻoe ka CDI, e hoʻomau ʻoe i ka hoʻopuka ʻana i ka nui o ka mimi wai (dilute), māmā ke kala, ʻoiai ke hoʻopuka mau nei ʻoe i kahi liʻiliʻi o ka mimi melemele ʻeleʻele, i hoʻopaʻa ʻia.

Hiki i kāu kauka ke kauoha i kēia mau hoʻokolohua e kōkua i ka ʻike ʻana iā CDI a hoʻopau i nā kūlana ʻē aʻe:

• He hoʻāʻo koko e nānā i ka pae o ka ADH (hormone antidiuretic) i loko o ke koko.
• He hoʻāʻo koko no ka nānā ʻana i nā pae glucose e hōʻoia i ka maʻi diabetes.
• ʻO ka urinalysis e nānā i ka nui (osmolality) o ka mimi a/a i ʻole e nānā i nā ketones, hiki ke hōʻike i ka maʻi diabetes.
• No ka hoʻoholo ʻana i ke ʻano o ka pane ʻana o kou mau puʻupaʻa, e hāʻawi ʻia ʻoe i kahi inikini o ka ADH synthetic. ʻAʻole pane ka poʻe me ka Nephrogenic Diabetes Insipidus i ka ADH synthetic no ka mea ua kūʻē ko lākou mau puʻupaʻa i nā hopena o ADH. Ma ka ʻaoʻao ʻē aʻe, pane ka poʻe me CDI i ka ADH synthetic.
• Hiki ke hoʻohana ʻia nā hoʻokolohua kiʻi e like me ka MRI (Magnetic Resonance Imaging) e hoʻoholo ai inā ua hōʻino ʻia kāu pituitary gland a i ʻole hypothalamus, a inā pēlā, he aha ke kumu.

He aha nā lāʻau lapaʻau no CDI?

ʻO ka mālama ʻana no CDI e pili ana i ke koʻikoʻi o ka hemahema o ka hormone ADH.

Loaʻa iā ʻoe kahi CDI piha.Inā pēlā, ʻo ka desmopressin ka lāʻau lapaʻau mua. He lāʻau lapaʻau kēia e hana ana e like me ka hormone ADH. Hiki iā ʻoe ke lawe i ka desmopressin ma ke ʻano he inikini, ma ke ʻano he pila, a i ʻole ma ke ʻano he pīpī ihu.

Inā loaʻa iā ʻoe ka CDI hapa , ʻo ia hoʻi ke hana nei ka ADH kūlohelohe i kekahi ʻano, hiki i kāu kauka ke kuhikuhi i nā lāʻau lapaʻau ʻē aʻe, e like me ka hydrochlorothiazide (HCTZ) .

Ma ke ʻano he lāʻau lapaʻau no nā pēpē ʻōpio me CDI, hiki ke hāʻawi ʻia ka waiū formula a i ʻole ka waiū umauma i hoʻoheheʻe ʻia me ka wai a hāʻawi ʻia me ka hydrochlorothiazide.

Aia kekahi mau hopena ʻaoʻao o Desmopressin?

ʻO ka Desmopressin ma ke ʻano laulā he lāʻau lapaʻau palekana loa me nā hopena ʻaoʻao liʻiliʻi. ʻO nā hopena ʻaoʻao paha:

• ʻEha poʻo.
• ʻEha ʻōpū.
• Ka luaʻi.
• Ka ihu paʻa a i ʻole ka ihu wai.
• Kokoke ka ihu.

Inā lawe nui ʻoe i ka desmopressin, a inā inu nui ʻoe i ka wai i ka wā e lawe ana, hiki i kou kino ke mālama i ka wai nui. Hiki i kēia ke hana i nā hōʻailona e like me:

• ʻEha poʻo.
• Pōʻaiʻī.
• Pehu.
• Ka haʻahaʻa o ka paʻakai (sodium) i loko o ke koko (Hyponatremia) .

Nā hōʻailona o ka Hyponatremia:

• ʻO ke poʻo ʻeha nui a lōʻihi paha.
• Ka huikau.
• Ka luaʻi a me ka luaʻi.

Inā loaʻa iā ʻoe nā hōʻailona o ka hyponatremia, pono ʻoe e kāhea i 911 a i ʻole e hele i ka lumi pilikia kokoke loa i ka hikiwawe loa.

Pehea e hiki ai i kekahi me CDI ke hoʻokele i kēia?

Inā loaʻa iā ʻoe ka CDI, me ka hoʻohui ʻana i ka lāʻau lapaʻau, he mea nui loa ia e inu wai mau i mea e pale aku ai i ka maloʻo ʻana.

He mea nui hoʻi e ʻike pinepine i kāu kauka e hōʻoia i ka hana pono ʻana o kāu lāʻau lapaʻau a ua pololei ka nui o ka lāʻau i kuhikuhi ʻia.

He aha nā kumu pilikia no ka hoʻomohala ʻana i ka CDI?

ʻO ka mea pōʻino, ʻaʻole hiki ke pale ʻia ka hapa nui o nā hihia o ka Central Diabetes Insipidus (CDI). ʻO nā kumu pilikia no ka hoʻomohala ʻana i ka CDI:

• ʻOki lolo.
• Loaʻa kahi moʻolelo ʻohana o ka maʻi diabetes insipidus a me/a i ʻole Wolfram syndrome.
• Nā ʻeha poʻo.
• Nā maʻi lolo.

He aha ke kūlana olakino o kekahi me CDI? (Prognosis)

ʻO ka wānana no kekahi me ka 'Central Diabetes Insipidus (CDI)' he maikaʻi ma ke ʻano laulā, a inā mālama pono ʻia a lawa ka wai i inu ʻia, ʻaʻole ia e hoʻoulu i nā pilikia nui.

Eia nō naʻe, ʻoi aku ka nui o ka pilikia o nā keiki ʻōpio, ka poʻe ʻelemakule, a me ka poʻe me nā pilikia olakino noʻonoʻo i nā pilikia a me ka make no ka mea he paʻakikī paha iā lākou ke ʻike i ko lākou make wai a i ʻole e hana.

He aha nā pilikia e hiki mai ana o ka Central Diabetes Insipidus (CDI)?

ʻO ka pilikia nui o CDIKa maloʻo ʻana o ka wai . ʻO ke ʻano kēia e nalowale ana kou kino i nā wai a me nā electrolytes e hana pono ai. Inā loaʻa iā ʻoe ka CDI, hiki iā ʻoe ke hoʻokele i ka nui o ka wai āu e nalowale ai i loko o kāu mimi ma ka inu ʻana i nā wai he nui. Akā inā ʻaʻole ʻoe, hiki iā ʻoe ke maloʻo koke.

He mea weliweli ka maloʻo ʻana o ka wai, a hiki ke hoʻoweliweli i ke ola. Inā loaʻa iā ʻoe nā hōʻailona o ka maloʻo ʻana o ka wai, e like me ka poniuniu, ka nausea, a me ka palaualelo, e hele koke i ka haukapila kokoke loa.

Inā ʻaʻole mālama ʻia ka CDI i nā pēpē ʻōpiopio , hiki i ka dehydration pinepine ke alakaʻi i nā pilikia e like me:

• Nā ʻōʻili.
• Ka pōʻino o ka lolo.
• Nā lohi o ka hoʻomohala ʻana.
• Ka ulu ʻana i hoʻopaneʻe ʻia.

Inā waiho ʻole ʻia ka CDI i ka mālama ʻole ʻia i nā keiki a me nā pākeke, nā pilikia e like me:

• Ka puʻuwai kūpono ʻole (Arrhythmia) .
• Kuni.
• Ka maloʻo o ka ʻili a me nā membrane mucous (e.g. i loko o ka waha, ihu).
• Nā ʻōʻili.
• Koma.

Hiki i nā pākeke me CDI ke loaʻa i kahi kūlana i kapa ʻia ʻo orthostatic hypotension , ʻo ia hoʻi ka hāʻule koke ʻana o ke koko i ke kū ʻana a i ʻole ka noho ʻana. Hiki i kēia ke hoʻoulu i ka poniuniu a i ʻole ka nalowale ʻana o ka ʻike no kekahi manawa.

Āhea ʻoe e ʻike ai i ke kauka?

Inā loaʻa iā ʻoe ka Central Diabetes Insipidus (CDI), he mea nui e ʻike pinepine i kāu kauka e nānā i kou kūlana a e hōʻoia i ka hana ʻana o kāu lāʻau. Inā loaʻa iā ʻoe kekahi mau hōʻailona e hopohopo nei iā ʻoe, e hōʻoia e hoʻomaopopo i kāu kauka.

Inā loaʻa iā ʻoe nā hōʻailona o ka make wai nui, e like me ka huikau a i ʻole ka nausea, e hele i ka lumi pilikia kokoke loa i ka hikiwawe loa.

Nā nīnau e nīnau aku ai i kāu kauka

Inā ua ʻike ʻia ʻoe me ka Central Diabetes Insipidus (CDI), he mea kōkua paha ke nīnau aku i kāu kauka i kēia mau nīnau:

• No ke aha i hoʻomohala ai au i ka CDI?
• He maʻi mau anei koʻu maʻi CDI a he manawa pōkole paha?
• He aha nā koho lapaʻau e loaʻa iaʻu?
• He aha nā pōmaikaʻi a me nā pōʻino o nā koho lapaʻau like ʻole?
• ʻEhia ka wai e pono ai iaʻu e inu i ka lā?
• He aha hou aʻe kaʻu e hana ai e mālama i koʻu kūlana?
• Aia anei koʻu ʻohana i ka pilikia o ka loaʻa ʻana o CDI?

ʻO ka mea hope loa, ʻo ka mea nui loa (Leka Lawe-Home)

He maʻi laha ʻole ka Central Diabetes Insipidus (CDI) akā he maʻi koʻikoʻi paha. ʻO ka nūhou maikaʻi, hiki ke mālama ʻia a hoʻokele ʻia.Inā loaʻa iā ʻoe ka CDI, he mea nui e ʻike pinepine i kāu kauka e hōʻoia i ka hana pono ʻana o kāu lāʻau. Inā he mau nīnau kāu e pili ana i kou kūlana, mai makaʻu e nīnau i kāu kauka. Aia lākou ma laila e kōkua iā ʻoe e hoʻokele i kou kūlana. Mai poina e inu i ka wai he nui, he mea nui loa ia!

ʻO ka Central Diabetes Insipidus, CDI, ADH, nā puʻupaʻa, nā hormones, ka mimi nui ʻana, ka makewai nui ʻana