Classification and Severity of Diabetes Insipidus

Interesting classification of DI, taken from Neurology India, groups DI into mild and severe based on some clinical and lab findings.

 

 

This was their protocol for diagnosis and management of DI in patients who underwent craniopharyngioma surgery.

 

Protocol for diabetes insipidus

• Diagnosis:  UO > 4ml/kg/h over 6 h perior OR Na >145 mEq/L with USG <1.005
• Monitoring
  • if drowsy, unable to drink – measure Is and Os hourly, sum every 6 hours
  • Foley until UO reasonably controlled
  • intraop Na if surgery >6h determines type of IV fluids and if pitressin required in OR
  • measure Na q6h day 1
  • measure Na q12h day 2 until stable x 3 days
  • measure Na daily x 1 week
• Treatment
  • Fluids until patient is awake and demonstrates intact thirst mechanism
    • 0.45% saline when UO 4-6 ml/Kg/h
    • D5W when UO >6ml/kg/h
  • DDAVP
    • day 1 – 5 unit IV boluses of pitressin
    • started as early as possible, usually on 2nd day, oral DDAVP 100 ug tablets of fractions of tablets
• Adequacy of control
  • based on serum Na rather than Is and Os
    • check frequency >150 or <130 or inc/dec by >10mEg/L in 1 day

 

Other pearls:

• Adipsia may be complication of hypothalamic damage
  • diminished thirst sensation
  • higher risk of developing hpyernatremia
  • require round the clock DDAVP
  • need to be trained to drink 2-3L water per day
  • gradually resolves with partial or complete thirst recovery by 9 months
• Polydipsic with high UO
  • patient compensating with increased PO intake, normal or low Na
  • at risk for water intoxication or hyponatremia
  • use oral rehydration solution rather than plain water

 

Reference:

Chacko, AriG et al. “Evaluation Of A Protocol-Based Treatment Strategy For Postoperative Diabetes Insipidus In Craniopharyngioma”. Neurology India 63.5 (2015): 712.