REMEMBERING PROF. N.N. GUPTA WITH HIS LECTURE ON NUMBNESS OF THE FEET

 

Prof. N.N. Gupta was the Head of the Department of Medicine when we were in our clinical semesters in King George’s Medical College, Lucknow. He was always immaculately dressed in formal whites with a starched and ironed white apron and was a strict disciplinarian. He was so punctual that you could set your watch when his car would reach the Medicine portico. His Chief Resident would receive him and his teaching round would start almost immediately. He looked keen and sincere and was an extremely meticulous person and a passionate teacher.  Unlike the spontaneity of Prof S.N. Chakraborty, his classes appeared to be choreographed and rehearsed to perfection. His Senior Resident would come first and after taking our attendance, would write on the blackboard the topic and the skeletal framework of the upcoming lecture. Then NNG, as he was fondly called, would come and deliver invariably an outstanding lecture. He would always start in time and finish in time, ask a few questions, mostly to his team of residents and postgraduate students, and leave. This is one of his lectures which I could salvage from my notes on “Management of Numbness of Feet’.

 

That feeling of numbness in feet and toes can be caused by a variety of conditions. Numbness is often accompanied by a tingling feeling, or crawling of ants, or pins and needles sensation, or simply walking on cotton or inability to feel the ground/floor. Patients have different ways of expressing this sensation. The cause may not be serious - it can be as uncomplicated as paresthesia (foot 'falling asleep'), however, it may be as serious as diabetes, multiple sclerosis, or a symptom of a much more serious condition. Whatever the cause may be, it's essential to address the numbness in feet. Avoiding doing so may affect your ability to walk.

 

Typical causes of numbness  

Numbness of the toes generally occurs due to conditions that affect the nerves or blood vessels of the foot. The most common causes of toe numbness include:

·        Compressed nerves of the foot from footwear

·        Injury to the foot

·        Nerve damage (neuropathy)

·        Poor blood circulation to the foot, usually due to diabetes and peripheral vascular disease

·        Diabetes

·        Irritation of nerves in the lower back (possibly due to a herniated inter-vertebral disk)

·        Frostbite

·        Stroke

·        Multiple sclerosis

·        Vasculitis (inflammation of the blood vessels)

 

Diagnosis

A detailed patient history is mandatory

·        History of Diabetes

·        When was Diabetes detected

·        History of glycemic control

·        History of target organ involvement

·        History of hospital admissions

·        History of previous foot involvement

Both legs and feet are to be inspected carefully

·        Dorsal and ventral aspects

o   Skin - Healthy, intact or cracked / Dry or shiny/ Turgor and texture/ hair loss

o   Blisters, Bunions, Corns, Calluses

o   Colour change with position – palor on elevation, rubor on dependency

·        Digits and Web spaces

o   Nails Normal and shiny or thick, dry, brittle / Pink in colour or discoloured

o   Fungal infection in nails or web

o   Ischemia

o   Gangrene

o   Nail beds clean and supple or dirty and rough

o   Ac. or Ch. Paronechoea

·        Deformities

o   Toes - Hallux valgus, Hammer toe, Claw toe, Prominent Metatarsal head

o   Forefoot and ankle - Flat foot, High medial arch, Rocker bottom foot, Charcot foot

·        Vascular examination

o   Peripheral pulses

o   Subpapillary venous plexus filling time (N</=3sec.)

o   Colour changes – Cyanosis, Dependent rubor, Erythema, Gangrene

o   Oedema

o   Temperature gradient

·        Neurological examination

o   Light touch – cotton wool

o   Two-point discrimination

o   Pain – pinprick

o   Vibration perception – tuning fork

o   Temperature perception – hot & cold

o   Deep tendon reflexes – ankle and knee

o   Babinski test

·        Examination of footwear

o   Is it well fitting and well padded?

o   Is it abnormally worn out at any site?

o   Is the sole padded and soft or thin and hard?

o   Are the dangerous pressure points or foot ulcers sufficiently offloaded?

o   Is the footwear front closed?

Very vital information is hidden in the footwear the patient is wearing and wecannot afford to miss them.

 

Management

Dealing with occasional numbness

1. Exercise - Sitting or standing in one place for a long time may cause numbness. To counteract the problem, stimulate circulation in the foot by asking the patient to move around. A short walk, or moving the foot while sitting down, will help too. In addition, bear in mind the following:

·        To begin with, regular exercise can help prevent numbness. So be sure to incorporate physical activity into your daily schedule.

·        If high impact exercises, such as jogging, causes numbness in the feet and toes, try lower impact exercises, such as swimming or cycling.

·        Before starting workout, advice to stretch well, wear appropriate shoes and exercise on level surfaces.

2. Change positions - Certain sitting positions may cause numbness in feet. Ask the patient to avoid sitting on their feet or sit cross legged  for a long period of time. Should they have to sit for long hours, they should elevate their feet periodically to increase the blood flow.

3. Avoid wearing excessively tight clothing - Pants, socks or other tight garments worn on the lower part of the body might restrict blood flow to the feet, causing numbness.

4. Massage the foot - Massaging the area of the foot that feels numb will help increase circulation and reduce the effects of occasional numbness.

5. Keep feet warm - The cold may cause numbness and tingling. Reduce the effects by staying warm with a pair of woolen socks, or heating pad or heated blanket.

6. Wear the right shoes - High heels or shoes that pinch the toes may cause numbness in the feet. This may also arise from wearing shoes that are too small for the patient’s feet, especially while exercising. They should opt for comfortable shoes that fit well.

7. Ask them to seek emergency treatment if their foot numbness is accompanied by symptoms such as weakness, paralysis, loss of bladder or bowel control, or slurring of speech.

8. Pregnancy may also cause swelling in the feet and toes, which could result in numbness. This is reversible and can be addressed by exercises and warmth.

 

Dealing with Numbness Related to Diabetes

1. Get a diagnosis - Chronic numbness in the feet and toes is often due to diabetes. The feeling of numbness occurs because it damages both the nerves and causes poor circulation in the feet. Numbness is usually one of the first symptoms of diabetes, so be sure to get Blood sugar estimation done, both fasting (11 hours fasting) and post prandial (1 ½ hr. PP). It can be extremely serious for a diabetic, as they may not be able to feel pain, which may be caused by heat, punctures or blisters in the feet. In addition, due to the restriction of blood to the feet, diabetics' feet heal at a slower pace. Consequently, infection is a serious concern. With scarce blood supply the bacteria get the liberty to proliferate in a pharmacological sanctuary.

2. Manage diabetes - The best way to prevent circulation issues and neuropathy is to keep the blood glucose levels in check.

·        Check blood sugar levels regularly.

·        While the numbness in feet may make it difficult to exercise, the patient should try to stay active. Aim for 40 minutes of exercise / brisk walking each day.

·        Eat well. Opt for a healthy, balanced diet that includes fruits, vegetables, whole grains, beans, fish and low-fat dairy.

·        Drastically cut down fat from your patient’s diet.

·        Avoid food that triggers blood sugar spikes - primarily anything sweet.

·        Insist on regular use of prescribed medicine and insulin.

·        Smoking can make the symptoms of  diabetes worse. Suggest quitting..

3. Lose weight - Obesity can be a contributing factor to numbness in the feet and toes. Consequently, losing weight will help alleviate the symptoms. In addition, it may also help lower blood pressure (which may also have an effect on the numbness).

4. Use products designed for diabetic foot care - Compression hose and socks help stimulate circulation, thereby decreasing numbness. Special lotions that contain capsaicin, may also be applied in order to relieve the numbness. Protective and well padded footwears are a must. Patients should never remain bare feet.

5. Avoid analgesics – NSAIDs are to be avoided in diabetics as their kidneys are at risk.

 

Dealing with chronic numbness, caused by other conditions

1. Treatment for injuries - Numbness can occur as a result of injuries to the feet, toes, ankles, head or spine. In which case, an orthopedist, neurologist or surgeon may help treat the injury and relieve the numbness.

2. Enquire about medications your patient is already taking - Numbness may also be caused by chemotherapy drugs and many other prescription drugs. If they experience numbness after starting a new medication, your patient should go back to the doctor who prescribed them. On this note, it is important to never stop taking your medication without talking to the prescribing doctor first.

3. Add vitamin supplements - Numbness may also be caused by a lack of vitamin B12 or other vitamins.

4. Prescribe medication for chronic conditions - Numbness in your feet and toes may also be a symptom of a number of underlying conditions, including multiple sclerosis, arthritis, Lyme disease and more. In which case, it is important that you treat and take medication for the underlying condition.

5. Reduce alcohol consumption - A numbing sensation in the limbs, particularly the feet and toes, may also be caused by heavy alcohol consumption.

Prof. N.N. Gupta was a wonderful clinician and even his bed side teachings were something we all looked forward to. He would make his residents demonstrate clinical signs like shifting dullness, systolic murmur, Adson's Test and we were expected to try the same tests during our evening ward teachings. Those were the days when we learnt how precious our time was with the patient, and how important it was to respect him and thank him for his cooperation. Prof. N.N. Gupta always greeted every patient and never failed to hold his hands, even when he was talking to us. He would invariably thank them before leaving their bedside. Every patient felt like a V.I.P and profusely praised him and his team. This was his way of stamping brand KGMC in our minds and hearts.

LONE WOLF TERROR ATTACKS

  

It is very difficult to understand the mysteries of the human mind. Religion and education were meant to calm it down towards rational thinking, but on odd occasions they doing just the reverse. Some religious faiths have, since ages, abandoned the concept of universal love and peaceful coexistence and always divided humanity into us and others. Now 'the lone jihadi syndrome' is one step ahead of this and this wolf does not have a pack, he hunts alone. He is angry, he is bitter, he is indoctrinated, he is committed and his world is simply divided into me and others. The fact that he hates others is well known, but whether he loves even himself is very doubtful. He invariably chooses to call himself a believer, but is he? What does he believe in, mass murder, mayhem, chaos?

 

What is a Lone Wolf Attack / Terrorism

Attacks committed by individuals unaffiliated to a terrorist group and are often referred to as ‘Lone Wolf Terrorism’. These are terror attacks perpetrated without the operational involvement of terrorist organizations in initiating, planning, or executing the attack. This phenomenon lacks a clear center of gravity directing the actions of “lone wolf” terrorists; and as such, it is crucial to understand the system of motivations influencing independent assailants to perpetrate attacks. Internet has created this new generation of terrorists who carry out a “leaderless jihad”

 

The concept of ‘lone wolf’ was popularized in the late 1990s by white supremacists Tom Metzger and Alex Curtis, who called upon like-minded individuals to “act alone” to commit violent crimes. However, the term is highly contested, and scholars disagree on its exact meaning. Still, they broadly agree that lone-wolf attackers operate as individuals or small groups without any assistance or formal links to a terrorist organization. Many times, lone wolves do not have any criminal background, and their activities tend to escape the security agencies’ surveillance, unlike organized terrorist groups.

 

Lone Wolf or Loneish Wolf or Untraceable Trail

An unsuccessful lone wolf, who gets caught, can claim allegiance to any terror outfit of his choice and a successful lone wolf, who has died, can be later adopted by any terror outfit to boost its notoriety and appeal in the dark world. So how lonely the wolf was actually is anybody’s guess. Then again, it would often be wrong to label perpetrators as “lone wolves” in the aftermath of attacks because failure to find the chain of perpetrators may be the reason he appears lonely. Only a small number of attackers are truly “lone wolf” and correctly meet that definition. The “true” lone wolves are individuals who strike without ever communicating with jihadist networks, either online or in person. The “‘lone wolf’ terrorists are often not completely out of contact, as they communicate through the “Dark Web”. They have their “virtual pack”. Online platforms provide them with many opportunities, such as finding instructions on building homemade bombs or mapping potential targets. So he is loneish and not exactly lone. 

 

It is a worldwide problem

Starting with the oft repeated schoolyard shootings in America this lone wolf terror is now seen in every continent. What makes these guys angry is not very clear. Is it poverty, illiteracy, lack of opportunities, lack of public recognition? A decorated Army veteran or a software engineer, a chemical engineer, or a merchant banker does not fit this description. A disgruntled schoolyard shooter usually has nothing in common with the decorated Army veteran who blew a Tesla truck laden with explosives in front of Trump International Hotel in Las Vegas, or Shamsuddin Jabbar, the New Year car attacker of Bouborn Street in New Orleans. 

America is not the only land of insane wolves. Europe has its own share as we saw in Nice in France where Mohamed Lahouaiej Bouhlel drove a 20 ton truck into a crowded market place killing 86 people and injuring more than 300! Germany saw Anis Amri drive a truck laden with steel beams into a busy Christmas market in Berlin, killing 12 and injuring 49 innocent people! Just the other day a practicing doctor, Taleb al Abdulmohsen repeated this same feat, driving his car into a crowded Christmas market, killing 5 and injuring over 200 people!

Asia Oceania too is not spared. The cowardly attack and horrific beheading of Kanhaiya Lal Teli on 28 June 2020, in Udaipur, Rajasthan, by two Islamic extremists has demonstrated that India is no longer immune from the violence perpetrated by lone-wolf terrorists. Palestinian terrorists perpetrated more than 550 "lone wolf" attacks in Israel between 2015 and 2017. They had widely varied motives including revenge for national, religious and personal humiliation, desire to die or get to paradise, national struggle, defense of al Aqsa Mosque, to proove himself / herself, or to gain self esteem. White supremacists lone wolf terror attack was witnessed in March 2019, when a lone wolf targeted two mosques in Christchurch, New Zealand, killing 51 people, while live-streaming his violent act.

 

Motives

·        The ideological motives group may include, inter alia, devotion to radical ideologies such as nationalist-separatist, communist, anarchist, fascist, or other political motives.

·        The personal motivations group may include

o   Economic motives such as poverty, low socioeconomic status, and acute economic crises); inter-personal motives (such as crises in the "lone wolf's" relationship with his/her parents, partner or another central figure in their life. 

o   Familial motives including hardship within the family, problematic or complex relationship between family members or a particular figure like mother, father, older siblings as well as the level appreciation or disrespect the "lone wolf" gets from his/her family. 

o   Other personal motives such as the desire for adventure, self image, or status improvement

o   Psychological motive that the terrorist suffers from may be a psychological instability, desire to commit suicide which may be caused by harsh experience, despair or belief in an afterlife.  

 

Role of Radicalization

Radicalization plays a critical role in the making of a lone-wolf terrorist, which mostly happens online through social media platforms, encrypted chat rooms on the darknet and propaganda on instant messaging apps. These virtual spaces enable like-minded extremist individuals to consume the propaganda and disinformation which acts as an enabler of violence. In cyberspace, particularly on the dark web, they also get access to training manuals and videos on operating weapons and making explosives by maintaining their anonymity. For instance, on 20 July 2011, a right-wing terrorist Anders Brevik targeted a youth camp in Oslo, Norway unleashing a horrendous terror attack, and killing 77 people. This was one of the first prominent lone-wolf terrorist attacks in recent memory. Bervik justified his act in his quest to ‘save European culture’ from Islamisation. His act was later supported on the social media platform by far-right individuals. In America some lone-wolf terrorists were radicalized in the military; some were radicalized in the workplace, and others on the internet. 

The Islamic State conducts most of its recruitment online in chatrooms and over encrypted communication apps. They use the death of thousands on Palestinians in Gaza as their recruitment pitches and instigate the lone wolves to carry out mayhem in western countries.

 

The Islamic lone wolf interprets his holy scriptures in accordance with the digital world echo-chamber of which he is usually a silent member. The cacophony of victimhood being inflicted on them by the non-believers of their faith fills them with rage and a very small incident in their life or family breaks the camel’s back and tilts them towards this suicidal path of terror.

 

How to stop the Lone Wolf attacks?

Terror attacks are the product of two main variables:

(i)                motivation to perpetrate an attack and

(ii)              operational capability to execute it.

Foiling terrorism may therefore be the outcome of limiting the motivations that
drive the attackers or, alternatively, curbing their capability to execute these attacks. Terrorism capabilities are usually assembled in a long process of preparations (e.g., procuring weapons, assembling explosive devices, and more) but these preparations have in many cases a clear “radar signature” available for intelligence detection. Therefore, many intelligence agencies focus on locating and identifying the operational preparations for a terror attack, then attempting to foil it. This “signature” is absent in many “lone wolf” attacks which are often perpetrated with a cold weapon. This kind of weapons can be found in every household (e.g., sharp object, knives, screwdrivers, axes, vehicles). Therefore, the importance of understanding the motivation of the “lone wolves” is essential for the prevention of this type of attacks. However, the motivations of “lone wolves” are difficult to locate and to neutralize.

One attack in Germany and one in France were perpetrated by a Tunisian immigrants and the last one in Germany by a Saudi doctor who had resided in Germany since 2006! The New Orleans attacker was a Texas born U.S citizen, but not a white American. This only furthers the MAGA mad nativist agenda that non-whites cannot be loyal to America and so racial abuse against them is OK. This insider outsider divide has now gone to the absurd end of targeting Indian over-achievers!

 

Modern terrorism is a dynamic and evolving phenomenon that keeps morphing. Over the years, terrorists around the world have been using a wide range of attacks, sometimes mimicking  successful attacks perpetrated by other terrorists in different arenas. In this way, waves of terror attacks (such as suicide bombings, hijackings, and ‘cold’ weapons attacks) have been carried out.  The “lone wolf’s” decision to perpetrate the attack is the product of balancing the sum of the various motives and inhibitions. His motives are ideological, psychological, personal and the sum of the various triggers he is exposed to (role model, traumatic event, incitement). His inhibitions are the product of his mental stability and his ability to contain crises, plus his value and belief system constrains as well as his cost/benefit analysis. When the sum of the triggers and motivations is greater than the inhibitions, then an attack is perpetrated.

 

 

ALWAYS THIRSTY - POLYDIPSIA - ANOTHER PROF. S.N. CHAKRABORTY MASTERCLASS

                                     

 

This is another master-class of Prof. S.N. Chakraborty which I have managed to recover from my notes of student days in King George’s Medical College in Lucknow. Prof. Chakraborty was our professor of Medicine and was an encyclopedia of knowledge. I have introduced Prof. Chakraborty to you in my previous blogs. If you have missed out on those blogs then please click:

https://www.blogger.com/blog/post/edit/8750887136313953221/188072368028650199

https://surajitbrainwaves.blogspot.com/2024/06/nail-examination-another-prof-sn.html

He walked into a packed lecture hall of students, as rowdy as only they can be, with a smiling face and mesmerized them by his spell into pin drop silence. Then he would have a hearty laugh, as that was his way of greeting students and ask “So what are we studying today?” Anyone could suggest a topic from his or her wish list, even his own bunch of residents who would always accompany him, busy picking up the pearls of wisdom, which he so generously offered them from time to time. Someone in the class that day suggested ‘polydipsia’ and he simply took off right from there! This was his style. I have worked and studied in four continents and have never seen another teacher so spontaneous and yet so organized.

 

Drinking water is, of course, great for health and essential for our body. But if you’re constantly parched and thirsty, despite having 8-10 glasses of water every day, there may be a larger issue to blame. The simplest explanation for feeling thirsty is not drinking enough water. We usually feel very thirsty after spending a long day under the sun or after a hard exercise session. But endless thirst isn’t normal and shouldn't be ignored. 

 

“So, how much water does a human body need”, the professor asked. When he did not get a satisfactory reply from the class he said "we should aim for half of our body weight in ounces of water each day. For example, a person who weighs 140 pounds, which will be approximately 65Kg he should aim for about 70 oz or 2 liters or about 10-12 glasses of water every day. If you find that your patient’s water intake is around this recommended mark and he/she still feels thirsty, this is polydipsia and this should be investigated. Now what will happen to this excess of water in the body? It will naturally be converted into urine and expelled. So usually polydipsia is associated with  polyurea, or excessive urination". 

Let us understand the causes of polydipsia:

1. Dehydration

Dehydration means excessive loss of body water. It happens when your body loses more fluids than you take in. Therefore, you end up feeling overly thirsty. Dehydration can happen more easily if you have diarrhea, diabetes, heatstroke, or when you’ve sweat too much after exercising. It can also be caused by drinking too much alcohol. It is a constant feature of extensive burns. So, take note of this symptom and make sure your patient drink enough fluids if you’ve been suddenly dehydrated. If that is not possible then intravenous fluid replacement must be planned. This is urgent, and no time can be wasted. If the skin is dry, shriveled, textureless, the tongue is dry and the eyes have sunken in their orbital socket, your patient is in extreme dehydration and urgent rehydration is required.

 

2. Dry mouth or xerostomia

Dry mouth, also known as xerostomia, can often be mistaken for extreme thirst. It’s a condition where the salivary glands in your mouth don't make adequate saliva to keep your mouth wet. Xerostomia is usually caused by certain medications like Atropine or aging issues or as a result of radiation therapy for cancer. Other causes include smoking tobacco or marijuana, stress, anxiety, or aging. When our glands don’t make enough saliva, we feel the need to drink more water. If the feeling of a dry mouth persists first try prescribing sialagogues. These are of two types:

• Peripheral sialagogues - Stimulate a gustatory response. For example, Amla or Indian gooseberry and lemon juice or lemondrops or pickles are sialagogues that promote saliva flow.
• Central sialagogues - Include parasympathomimetics such as pilocarpine. Central sialagogues have more side effects than peripheral sialagogues.

 

3. Eating way too much salt

Just like it’s important to keep our sugar intake in check, we must also keep an eye on the amount of salt we consume every day. Our kidneys process excess salt and redirect it into our urine. When we eat a sodium-heavy meal, our kidneys have to work extra hard to get rid of the salt. Thus, you end up urinating more than usual. Overdoing it on sodium-heavy meals can also lead to high blood pressure over time and may cause kidney or heart damage as well. Adults should limit sodium intake to less than 2,300 mg per day – that’s almost 1 teaspoon of table salt. So check and see if your patient is going over this limit and cut down on their salt intake if needed.

 

4. Diabetes

Diabetes can increase your risk of dehydration. When someone has diabetes, their body doesn’t make enough insulin, and this leads to too much sugar (or glucose) building up in their body. The glucose in urine pulls in more water by osmosis, and hence, these patients are forced to urinate more often than usual. This makes them experience extreme thirst, as their body wants to replace the fluids it is losing. So, excessive thirst along with excessive urination and blurred vision, should always raise the red flag of diabetes.

 

5. Anemia

Anemia is a condition in which the body loses healthy red blood cells faster than it- can be replaced. This leads to a deficiency of oxygen in various organs and tissues of the body. While mild anemia usually won’t cause excessive thirst, severe anemia might lead to uncontrolled thirst. Anaemai is caused by underlying diseases, a poor diet, or heavy bleeding. Estimation of haemoglobin and study of the general blood picture establishes the type of anaemia and its cause can then be studied by detailed examination and investigations including urine and stool examination, liver, kidney and thyroid functions and endoscopies and radiological investigations.

 

6. Having too many diuretic foods

Diuretic foods and drinks can help you get rid of excess water and sodium from your body. They force the kidneys to excrete more sodium into the urine. As the sodium is flushed away, the body gets rid of water as well. Diuretics are usually prescribed when the body is retaining too many fluids. But overdosing on them will make your patient thirsty because they deplete the fluids in their body, causing an electrolyte imbalance. Some fruits and vegetables that act as natural diuretics include:- Pineapple- Watermelon- Cucumber- Celery- Cabbage- Beets- Asparagus- Watercress- Pumpkin seeds- Lemon. Commonly consumed diuretic beverages include coffee, tea, and lemon juice, among others. So, if your patient is having too many diuretic foods daily, it may trigger excessive thirst. Cut down on them a little to maintain a healthy balance.

 

7. Low-carbohydrate diets

Following a low-carbohydrate diet may be working wonders for your patient’s health, but it is likely to cause dry mouth and frequent thirst. That happens because carbohydrates hold on to more water than proteins or fats. When you stop eating carbohydrates, all the extra fluids get released through urination. Since your body is excreting more water, it causes a spike in your thirst levels. Thus, make it a point to drink enough water when you are following a low-carbohydrate diet.

 

8. Hyper-calcemia

Hyper-calcemia is a condition where the calcium level in your blood is above normal. Extra calcium in the body makes the kidneys work harder to filter it. This can make a person urinate more often, leading to increased thirst and even dehydration. Hypercalcemia can also cause stomach upsets, nausea, vomiting, bone pain, and constipation. Serum electrolyte estimation will diagnose this condition and it is easily correctable.

 

9. Chronic stress and anxiety

Chronic stress and anxiety may cause you to sweat, thus leading to serious thirst. Anxiety can cause dry mouth, and dry mouth can feel like thirst. Hence, your brain might be fooled into believing that you need to drink water even though you aren’t really thirsty. Also, chronic stress messes with your adrenal glands and can result in low blood pressure. This can then give rise to dizziness, anxiety, and extreme thirst, say health professionals. Thus, in case your patient has been unduly stressed about something, work towards managing it better.

 

10. Neuro-developmental disorders: 

Polydipsia can be a symptom of neuro-developmental disorders, such as autism and intellectual disabilities. 

 

11. Kidney diseases.

Chronic renal failure, urinary tract infection, and renal diabetes insipidus can cause polydipsia. DI can be caused by a number of conditions, including:

• Central DI: The pituitary gland is damaged, which prevents it from producing enough vasopressin, a hormone that regulates water balance. This is often inherited in infants and children. 
• Nephrogenic DI: The pituitary produces enough vasopressin, but the kidneys don't recognize it. This can be caused by inherited or acquired kidney disease, certain medications, low potassium levels, high calcium levels, or a blocked urinary tract.
• Gestational DI: This is very rare. It's caused by the placenta producing an enzyme that breaks down vasopressin, or the pregnant person producing more prostaglandin, which makes the kidneys less sensitive to vasopressin.
  
  

DI patients, unlike Type 1 and 2 Diabetes Mellitus patients have normal blood sugar levels. Prompt diagnosis and treatment of DI is important to prevent severe dehydration, which can lead to brain damage or impaired mental function. 

 

That is how another Prof. Chakraborty’s class concluded. I would invite all his students, who routinely read my blogs, to contribute their own anecdotes about this wonderful teacher in the comment section.