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Run npx skillmds@latest add dromlakhani/ata-di-workup in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Ata Di Workup by dromlakhani — Agent Skill

Name: Ata Di Workup
Rating: 4.666666666666667 (3 reviews)
Author: dromlakhani

Ata Di Workup

This skill guides the simultaneous measurement of serum and urine osmolarity to evaluate polyuria for central diabetes insipidus. It is triggered when a patient presents with polyuria exceeding 50 mL/kg/24 hours or 3.5 L/day in a 70‑kg individual.

dromlakhani Updated Aug 19, 2026 10 repo stars

File contents

Workup polyuria for central diabetes insipidus

STEP 1 — Gather Information

Confirm polyuria: urine output >50 mL/kg/24 h or >3.5 L/24 h in a 70‑kg adult.
Measure serum osmolarity (mOsmol/L).
Measure urine osmolarity (mOsmol/L).
Perform urine dipstick for glucose.
Record patient weight if needed for volume threshold.

STEP 2 — Rule In / Rule Out

Is serum osmolarity >295 mOsmol/L?
- No → Consider non‑DI causes of polyuria (e.g., primary polydipsia, osmotic diuresis); stop DI workup here.
- Yes → Proceed to step 3.

STEP 3 — Classify or Stratify

Calculate urine:serum osmolarity ratio (urine ÷ serum).
Is urine osmolarity ≈600 mOsmol/L and ratio ≥2 and urine dipstick negative for glucose?
- Yes → Classify as consistent with central diabetes insipidus.
- No → Consider nephrogenic DI, hyperglycemia‑induced osmotic diuresis, or primary polydipsia; pursue further testing (e.g., water deprivation test, ADH challenge).

STEP 4 — Decide

If central DI is confirmed, initiate a therapeutic trial with desmopressin or proceed to formal water deprivation test for definitive diagnosis.
If DI is not confirmed, investigate alternative etiologies of polyuria based on clinical context.

Clinical Guardrails / Mimics / Pitfalls

Do not diagnose DI based on a single urine osmolarity without simultaneous serum; hyperglycemia can artifactually raise urine osmolarity.
Rule out osmotic diuresis (glucose, mannitol) by ensuring urine dipstick is negative for glucose and serum glucose is normal.
Primary polydipsia may show low urine osmolarity despite high fluid intake; a water deprivation test helps differentiate.
Nephrogenic DI presents with high serum osmolarity but inappropriately low urine osmolarity (<300 mOsmol/L) despite ADH administration.
Avoid using random urine samples; timed collections improve accuracy.

Concrete Clinical Example

A 65‑kg man reports 4 L/day urine output. Serum osmolarity 302 mOsmol/L, urine osmolarity 610 mOsmol/L, urine dipstick negative for glucose. Ratio = 610/302 ≈ 2.0. Meets criteria for central diabetes insipidus.

Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2118

TODO: consider adding scripts/calc.py for the ata-di-workup calculator

---name: ata-di-workupdescription: This skill guides the simultaneous measurement of serum and urine osmolarity to evaluate polyuria for central diabetes insipidus. It is triggered when a patient presents with polyuria exceeding 50 mL/kg/24 hours or 3.5 L/day in a 70‑kg individual.---# Workup polyuria for central diabetes insipidus## STEP 1 — Gather Information- Confirm polyuria: urine output >50 mL/kg/24 h or >3.5 L/24 h in a 70‑kg adult.- Measure serum osmolarity (mOsmol/L).- Measure urine osmolarity (mOsmol/L).- Perform urine dipstick for glucose.- Record patient weight if needed for volume threshold.## STEP 2 — Rule In / Rule Out- Is serum osmolarity >295 mOsmol/L? - **No** → Consider non‑DI causes of polyuria (e.g., primary polydipsia, osmotic diuresis); stop DI workup here. - **Yes** → Proceed to step 3.## STEP 3 — Classify or Stratify- Calculate urine:serum osmolarity ratio (urine ÷ serum).- Is urine osmolarity ≈600 mOsmol/L **and** ratio ≥2 **and** urine dipstick negative for glucose? - **Yes** → Classify as consistent with central diabetes insipidus. - **No** → Consider nephrogenic DI, hyperglycemia‑induced osmotic diuresis, or primary polydipsia; pursue further testing (e.g., water deprivation test, ADH challenge).## STEP 4 — Decide- If central DI is confirmed, initiate a therapeutic trial with desmopressin or proceed to formal water deprivation test for definitive diagnosis.- If DI is not confirmed, investigate alternative etiologies of polyuria based on clinical context.## Clinical Guardrails / Mimics / Pitfalls- Do not diagnose DI based on a single urine osmolarity without simultaneous serum; hyperglycemia can artifactually raise urine osmolarity.- Rule out osmotic diuresis (glucose, mannitol) by ensuring urine dipstick is negative for glucose and serum glucose is normal.- Primary polydipsia may show low urine osmolarity despite high fluid intake; a water deprivation test helps differentiate.- Nephrogenic DI presents with high serum osmolarity but inappropriately low urine osmolarity (<300 mOsmol/L) despite ADH administration.- Avoid using random urine samples; timed collections improve accuracy.## Concrete Clinical ExampleA 65‑kg man reports 4 L/day urine output. Serum osmolarity 302 mOsmol/L, urine osmolarity 610 mOsmol/L, urine dipstick negative for glucose. Ratio = 610/302 ≈ 2.0. Meets criteria for central diabetes insipidus.**Source:** Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2118> **TODO:** consider adding scripts/calc.py for the ata-di-workup calculator

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