The body gives us signals that warn us of a possible disease. One such warning may come from urine, a change in color, or high urine volume. What happens when the child has a constant need to urinate? What causes makes the little one pee continuously? Is it a serious illness? We give answers to all these questions!
When parents come to my office for reasons related to a supposed urinary pathology, such as the concern that their child causes them to pee many times a day and, even at night, it is difficult for me in the first instance to specify what They consider them 'many times' and, above all, determine the amount of urinary volume in 24 hours.
And it is that quantifying the urinary volume is complicated when the child is under 2 years of age, who still wears diapers and, therefore, is still able to control sphincters. For this reason, in addition to asking about family history, I must perform a thorough physical examination and support myself in a series of paraclinical examinations that will help me reach an accurate diagnosis, take appropriate behavior and solve the pathology.
The normal urinary volume in childhood is 1 to 3 ml / kg / hour. When this amount is greater, we can speak of polyuria, but the fact of urinating many times a day, without exceeding the normal volume, is not considered that the child has polyuria, so it is important to know other terms that are related to this pathology:
When the fluid intake is excessive. It is closely related to polyuria, since it could be the cause of an increase in urine volume in hemodynamically stable children or it could be a compensatory mechanism for polyuria.
It is when the voiding frequency is higher than normal, unrelated to the volume of urine. It can occur in large polyuria or when the capacity of the bladder is small.
It is when the child wakes up at night more than once to urinate. It can be a nocturnal polyuria or a small capacity of the bladder.
The mechanisms by which an excessive loss of water occurs in the urine can be several: inadequate reabsorption of water at the level of the renal tubules (primary polydipsia due to an alteration of the thirst center, congenital or acquired pathologies of the kidney and tumors, trauma or drugs) and inability to rescue solutes, producing osmotic or gradient diuresis (diabetes mellitus, kidney failure, tubulopathy, mineral losses: sodium, chlorine, potassium, bicarbonate, phosphorus).
In the consultation, during the questioning of the parents, it is also important to focus on the pathological history of the child, looking for diseases that could condition the existence of polyuria, such as:
- Hypoplastic or poorly developed kidneys
- Congenital obstruction of the urinary tract
- Urinary infections
- Chronic renal insufficiency
- Acute cystitis
- Diabetes mellitus or diabetes insipidus
- Pathomania, that is, a conduct disorder in which the child compulsively drinks a lot of water, which leads to secondary polyuria due to excess intake
The first thing is to take a good medical history of the patient, emphasizing the pathological history of the child (urinary infections, diabetes, neurological disorders, cranial trauma, intracranial tumors, meningitis, hydroelectrolyte imbalance, alteration in the development of the body-stature and psychomotor, state nutrition and hydration) and family history.
After this first consultation, the procedure to follow would be:
- Do a thorough physical examination, giving importance to the heart rate, ventilatory rate, central venous pressure, presence of edema, ascites or pleural effusions.
- And request complete blood biochemistry analysis, venous blood gas and urine test of the first and second urination in the morning, to determine electrolytes in urine.
- And after having the diagnosis, your treatment will depend on the cause that is producing polyuria.
My recommendations regarding this pathology are:
- Consult immediately with the pediatrician if you observe or the child refers abundant or very frequent urine, even if there is enuresis, which is when the child urinates the bed.
- Pending if you also have other symptoms such as fever, weakness, cramps, headache, vomiting, dysuria ...
- Do not self-medicate, much less offer herbal teas or herbal teas or branches, as it could aggravate kidney disease.
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