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Diabetes Insipidus (DI)






  • Central DI:

    • ↓ secretion ADH

    • Most often idiopathic or induced by trauma, pituitary surgery, or hypoxic or ischemic encephalopathy

  • Nephrogenic DI:

    • Normal ADH secretion but kidneys are resistant to its water-retaining effect

  • Diagnosis:

    • ​Dilute urine (<150 mOsm/L)

    • Hypernatremia (Na>150)

    • Hyper-osmolality (>290)





  • Hypernatremia:

    • Altered level of consciousness, seizures, coma, hyperreflexia

    • Risk of intracranial hemorrhage with acute, severe hypernatremia

    • ↑ MAC requirements 

  • Volume depletion:

    • Resuscitate with normal saline initially

  • Associated conditions:

    • Neurogenic (pituitary surgery, traumatic brain injury, tumor, idiopathic)

    • Nephrogenic (chronic renal failure, lithium toxicity, hypercalcemia, hypokalemia, congenital, fluoride toxicity)





  • Consultation with nephrology may be valuable

  • Treat hypernatremia by estimating water deficit & replacing with free water:

    • ​Water deficit = total body water x (Serum Na [    ]/140-1)

  • Central DI​: desmopressin 1-2 mcg IV BID  

  • Nephrogenic DI: hydrochlorothiazide/amiloride

  • Complications of treatment:

    • Avoid rapid overcorrection if chronic hypernatremia (goal = <10 mEq/day) 

    • Cerebral edema, water intoxication, volume overload



Potential conflicts


  • Emergency surgery vs. need for optimization of electrolytes/volume status




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