Treatment of central diabetes insipidus
- Daniel G Bichet, MD
Daniel G Bichet, MD
- Professor of Medicine
- Universite de Montreal
- Section Editors
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor Emeritus
- University of Rochester School of Medicine and Dentistry
- Michael Emmett, MD
Michael Emmett, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Chief of Internal Medicine
- Baylor University Medical Center
- Joseph I Wolfsdorf, MB, BCh
Joseph I Wolfsdorf, MB, BCh
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Harvard Medical School
The major symptoms of central diabetes insipidus (DI) are polyuria, nocturia, and polydipsia due to the concentrating defect. Treatment of this disorder is primarily aimed at decreasing the urine output, usually by increasing the activity of antidiuretic hormone (ADH, also called arginine vasopressin or AVP).
Replacement of previous and ongoing fluid losses is also important. Most patients with central DI have a normal or only mildly elevated plasma sodium concentration because concurrent stimulation of thirst minimizes the degree of net water loss. However, hypernatremia can occur if thirst is impaired or the patient has no access to water . Correction of the hypernatremia requires repair of this free water deficit. (See "Treatment of hypernatremia".)
The treatment of central DI will be reviewed here. The causes of this disorder and the approach to the patient with polyuria are discussed separately. (See "Clinical manifestations and causes of central diabetes insipidus" and "Diagnosis of polyuria and diabetes insipidus".)
CHOICE OF THERAPY
There are three main options for the treatment of polyuria in patients with central DI:
●Desmopressin, which is an ADH analog and is the preferred drug in almost all patients.
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- CHOICE OF THERAPY
- THERAPEUTIC GOAL
- Risk of hyponatremia
- - Dosing to prevent hyponatremia
- Course of DI and duration of therapy
- OTHER DRUGS
- Carbamazepine or clofibrate
- Thiazide diuretics
- Older children
- Infants and small children
- - Low-solute diet and thiazide diuretics
- - Subcutaneous desmopressin therapy
- - Monitoring of serum sodium
- PROBLEM WITH INTRAVENOUS FLUID REPLACEMENT
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS