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Diabetes Insipidus Daily Monitoring Log

Patient Self-Tracking Sheet for Fluid Balance and Symptoms

Endocrinology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date: _________________ Medication(s): _________________ Dose: _________________

Daily Fluid Balance Tracking

Input Monitoring

Time Fluid Intake (mL) Type of Fluid
6 AM
9 AM
12 PM
3 PM
6 PM
9 PM
Night

Output Monitoring

Time Urine Output (mL) Color/Clarity
6 AM
9 AM
12 PM
3 PM
6 PM
9 PM
Night

Symptom Tracking

Daily Symptoms (Check if present)

  • Excessive thirst
  • Dry mouth
  • Fatigue
  • Headache
  • Dizziness
  • Mental confusion

Body Weight

Morning weight: _______ kg Evening weight: _______ kg

Additional Notes

Blood pressure: / Other symptoms or concerns: ________________________

Bring this log to all endocrinology appointments

Target Ranges

  • Daily fluid intake goal: _______
  • Urine specific gravity goal: _______
  • Weight variation limit: ± _______ kg

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