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Treatment of central diabetes insipidus

Daniel G Bichet, MD
Section Editors
Richard H Sterns, MD
Michael Emmett, MD
Joseph I Wolfsdorf, MB, BCh
Deputy Editors
John P Forman, MD, MSc
Alison G Hoppin, MD


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 [1-3]. 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".)


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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Literature review current through: Nov 2017. | This topic last updated: Dec 12, 2017.
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