Pediatric Diabetes Insipidus Treatment & Management
- Author: Karl S Roth, MD; Chief Editor: Stephen Kemp, MD, PhD more...
Treat patients with diabetes insipidus (DI) in an inpatient setting because of the risk of severe dehydration. Destructive or compressive intracranial lesions mandate inpatient stay. Demonstration of an intracranial mass necessitates surgical care.
Distinguishing between central and nephrogenic etiologies is essential to treatment. Transfer to an academic center is highly advised for initial diagnosis and treatment, especially because central DI may require involved diagnostic studies and neurosurgical or oncologic treatment. Surgical procedures of any kind require replacement of fluids at a much higher rate than normal maintenance; inattention to this may result in serious consequences.
Subsequent admissions are determined by the need for intravenous (IV) rehydration, especially during intercurrent gastrointestinal (GI) illnesses.
For central DI, the treatment of choice is desmopressin (a synthetic vasopressin analogue). It is available in parenteral, intranasal, and oral dosage forms. The doses widely vary depending on the preparation used, so take care to correctly calculate the dose. Other useful medications include chlorpropamide and thiazide diuretics. The latter 2 can result in a 25-75% reduction in urine volume and can be used in combination with each other.
Nephrogenic DI cannot be effectively treated with desmopressin, because the receptor sites are defective and the kidney is prevented from responding. Thiazide diuretics, amiloride,[12, 13] and indomethacin or aspirin are useful when coupled with a low-solute diet.
Aqueous vasopressin (Pitressin) and desmopressin (DDAVP) preparations are available for intravenous (IV) use in emergency circumstances. Overtreatment with desmopressin can result in hyponatremia and seizures.
Diet and Activity
Provide affected infants with a breast milk diet to decrease solute load. Protein should account for 6% of caloric intake, and sodium should be reduced to 0.7 mEq/kg/day.
Provide young children with 8% of their caloric intake in the form of protein to enable normal growth. Sodium intake must be maintained at 0.7 mEq/kg/day. (See the video below.)Carbs for Kids-Count Them In: The Constant Carbohydrates Diet.
Activities resulting in increased insensible water loss should be moderated in the presence of massive urinary water loss to prevent dehydration. Heat exposure should be minimized, especially when participating in sports. Avoid creating barriers to drinking water.
Consultations and Long-Term Monitoring
Consultation with the following specialists may be appropriate:
- Endocrinologist - The presence of central DI should prompt an evaluation of anterior pituitary function.
- Diagnostic radiologist
Regular follow-up visits with an endocrinologist (for central DI) or a nephrologist (for nephrogenic DI) are necessary for dosage adjustment. When indomethacin is used in long-term therapy, carefully observe renal function for any signs of toxicity.
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