Pediatric Arginine Vasopressin Disorders (Diabetes Insipidus) Clinical Presentation

Updated: Aug 24, 2023
  • Author: Karl S Roth, MD; Chief Editor: Robert P Hoffman, MD  more...
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Diagnosis of arginine vasopressin (AVP) disorder (diabetes insipidus) may be difficult in infants and children because of nonspecific presenting features (eg, poor feeding, failure to thrive, irritability). Accordingly, a high index of suspicion is necessary.

The earliest signs of AVP disorder include a vigorous suck with vomiting, fever without apparent cause, constipation, and excessively wet diapers from urination. In older infants and young children, irritability is generally due to a borderline state of dehydration coupled with hypernatremia and, sometimes, fever. Nocturia is common and expected because of increased urine production. AVP deficiency (central diabetes insipidus) tends to develop suddenly.


Physical Examination

The typical examination reveals an irritable infant with a dripping wet diaper, along with detectable signs of dehydration (eg, dry mucous membranes, diminished skin turgor, decreased tearing, tachycardia). Often, skin turgor is not diminished in individuals with hypernatremic dehydration despite significant dehydration. In severely dehydrated patients, the pulse may be thready and rapid. Hypotension may be present because of hypovolemic shock. Mobile fecaliths may be palpable in the abdomen.