Infants ingest relatively large amounts of low renal solute load fluids, either as breast milk or formula, and have a relatively high volume of dilute urine output to maintain sodium/water homeostasis. In diabetes insipidus, increased fluid turnover is managed by increased free water intake and/or decreased urine output. Treat patients with diabetic insipidus in an inpatient setting because of the risk for severe dehydration. Destructive or compressive intracranial lesions mandate inpatient stay. Demonstration of an intracranial mass necessitates surgical care.
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.
For central diabetes insipidus, 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, which can result in a 25%-75% reduction in urine volume and can be used in combination with each other.
Thiazide diuretics, amiloride, and indomethacin or aspirin are useful when coupled with a low-solute diet. This approach does not normalize urine output and continues to necessitate increased oral fluid intake.
For more on pediatric diabetes insipidus, read here.
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Cite this: Romesh Khardori. Fast Five Quiz: Test Your Knowledge of Diabetes Insipidus - Medscape - May 30, 2018.