Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
This article is written from a secondary care perspective. In thirty years of primary care, I have seen perhaps two or three new patients with polyuria and polydipsia per year. While it is clearly crucial to test the urine for glucose to exclude diabetes mellitus as a cause for the polyuria, most patients turn out to have primary polydipsia. This is simply the habit, built up over time, of drinking large amounts of water.The belief that this is healthy is common, and so is the habit. Simple advice and explanation that reducing fluid intakes over a number of weeks is required, and suffices in most cases.
Will we miss the vanishingly rare case of diabetes insipidus? Clearly instruction to return if the problem does not settle should be given. The index case in your article is described as having frequent nocturia. This is is not the case in primary polydipsia, and should rightly trigger further investigation along the lines advocated by the authors
Re: Investigating polyuria
This article is written from a secondary care perspective. In thirty years of primary care, I have seen perhaps two or three new patients with polyuria and polydipsia per year. While it is clearly crucial to test the urine for glucose to exclude diabetes mellitus as a cause for the polyuria, most patients turn out to have primary polydipsia. This is simply the habit, built up over time, of drinking large amounts of water.The belief that this is healthy is common, and so is the habit. Simple advice and explanation that reducing fluid intakes over a number of weeks is required, and suffices in most cases.
Will we miss the vanishingly rare case of diabetes insipidus? Clearly instruction to return if the problem does not settle should be given. The index case in your article is described as having frequent nocturia. This is is not the case in primary polydipsia, and should rightly trigger further investigation along the lines advocated by the authors
Competing interests: No competing interests