Materiały źródłowe

• #1 Diabetes insipidus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/diagnosis-treatment/drc-20351274

  If you have mild diabetes insipidus, you may only need to drink more water to avoid dehydration. In other cases, treatment typically is based on the type of diabetes insipidus. […] If central diabetes insipidus is caused by a disorder in the pituitary gland or hypothalamus, such as a tumor, that disorder is treated first. […] When treatment is needed beyond that, a manufactured hormone called desmopressin (DDAVP, Nocdurna) is used. This medication replaces the missing antidiuretic hormone (ADH) and lowers the amount of urine the body makes. Desmopressin is available as a pill, as a nasal spray and as a shot. […] If you have central diabetes insipidus, it’s likely that your body still makes some ADH. But the amount can change from day to day. That means the amount of desmopressin that you need also may change. Taking more desmopressin than you need can cause water retention. In some cases, it may cause potentially serious low sodium levels in the blood. Talk to your health care provider about how and when to adjust your dosage of desmopressin.

• #1 Diabetes Insipidus Treatment & Management: Approach Considerations, Postoperative Setting, Consultations

  https://emedicine.medscape.com/article/117648-treatment

  Most patients with diabetes insipidus (DI) can drink enough fluid to replace their urine losses. When oral intake is inadequate and hypernatremia is present, replace losses with dextrose and water or an intravenous (IV) fluid that is hypo-osmolar with respect to the patients serum. Do not administer sterile water without dextrose intravenously, as it can cause hemolysis. […] In patients with central DI, desmopressin is the drug of choice. A synthetic analogue of antidiuretic hormone (ADH), desmopressin is available in subcutaneous, IV, intranasal, and oral preparations. Generally, it can be administered 2-3 times per day. Patients may require hospitalization to establish fluid needs. Frequent electrolyte monitoring is recommended during the initial phase of treatment. […] Alternatives to desmopressin as pharmacologic therapy for DI include synthetic vasopressin and the nonhormonal agents chlorpropamide, carbamazepine, clofibrate (no longer on the US market), thiazides, and nonsteroidal anti-inflammatory drugs (NSAIDs). Because of side effects, carbamazepine is rarely used, being employed only when all other measures prove unsatisfactory. NSAIDs (eg, indomethacin) may be used in nephrogenic DI, but only when no better options exist.

• #1 Diabetes Insipidus Treatment & Management: Approach Considerations, Postoperative Setting, Consultations

  https://emedicine.medscape.com/article/117648-treatment

  In central DI, the primary problem is a hormone deficiency; therefore, physiologic replacement with desmopressin is usually effective. Use a nonhormonal drug for central DI if response is incomplete or desmopressin is too expensive. […] Monitor for fluid retention and hyponatremia during initial therapy. Follow the volume of water intake and the frequency and volume of urination, and inquire about thirst. Monitor serum sodium, 24-hour urinary volumes, and specific gravity. Request posthospitalization follow-up visits with the patient every 6-12 months. Patients with normal thirst mechanisms can usually self-regulate. […] No specific dietary considerations exist in chronic DI, but the patient should understand the importance of an adequate and balanced intake of salt and water. A low-protein, low-sodium diet can help to decrease urine output.

• #1 Diabetes insipidus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/diagnosis-treatment/drc-20351274

  Because the kidneys don’t properly respond to ADH in this form of diabetes insipidus, desmopressin won’t help. Instead, your health care provider may advise you to eat a low-salt diet to lower the amount of urine your kidneys make. […] Treatment with hydrochlorothiazide (Microzide) may ease your symptoms. Although hydrochlorothiazide is a diuretic a type of medicine that causes the body to make more urine it can lower urine output for some people with nephrogenic diabetes insipidus. […] Treatment for gestational diabetes insipidus involves taking the manufactured hormone desmopressin. […] There is no specific treatment for this form of diabetes insipidus other than lowering the amount of fluids you drink. If the condition is related to a mental illness, treating that may ease symptoms.

• #1 Diabetes Insipidus – NIDDK

  https://www.niddk.nih.gov/health-information/kidney-disease/diabetes-insipidus

  How do health care professionals treat diabetes insipidus? The main way to treat diabetes insipidus is to drink enough liquids to prevent dehydration. But doing so can disrupt your regular lifestyle, including your sleep. Your health care professional may refer you to a specialist, such as a nephrologist or an endocrinologist for more specific treatments. Other treatments vary by cause. […] Health care professionals most often treat central diabetes insipidus with a man-made hormone called desmopressin, which replaces the vasopressin your body is not making. You can take this medicine as a nasal spray, a pill, or a shot. […] In some cases, nephrogenic diabetes insipidus may go away after treating its cause. For example, switching medicines or taking steps to balance the amount of calcium or potassium in your body may be enough to resolve the problem. Your health care professional may also prescribe a class of diuretic medicines called thiazides to help reduce the amount of urine your kidneys make. Other treatments can include nonsteroidal anti-inflammatory drugs or other types of diuretics.

• #1

  https://www.nhs.uk/conditions/diabetes-insipidus/treatment/

  Treatments for diabetes insipidus aim to reduce the amount of urine your body produces. […] Depending on the type of diabetes insipidus you have, there are several ways of treating your condition and controlling your symptoms. […] As your condition is caused by a shortage of AVP, your GP or endocrinologist may prescribe a treatment that takes the place of AVP, known as desmopressin. […] Desmopressin is a manufactured version of AVP that’s more powerful and more resistant to being broken down than the AVP naturally produced by your body. […] Desmopressin can be taken as a nasal spray, in tablet form or as a form that melts in your mouth, between your gum and your lip. […] If you have more severe AVP-R, you may be prescribed a combination of thiazide diuretics and a non-steroidal anti-inflammatory drug (NSAID) to help reduce the amount of urine your kidneys produce. […] Thiazide diuretics can reduce the rate the kidneys filter blood, which reduces the amount of urine passed from the body over time. […] Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce urine volume further when they’re used in combination with thiazide diuretics.

• #1 Diabetes Insipidus: A Pragmatic Approach to Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7785480/

  Patients with partial nephrogenic DI may be responsive to desmopressin. […] In the postoperative period, DI should be suspected if there is polyuria with or without hypovolemia. […] A single dose of subcutaneous or intravenous desmopressin can be administered. […] Management includes the correction of any water deficit and the use of specific pharmacological agents including desmopressin, thiazides and amiloride.

• #1 Diabetes Insipidus – NIDDK

  https://www.niddk.nih.gov/health-information/kidney-disease/diabetes-insipidus

  Researchers haven’t found an effective way to treat dipsogenic diabetes insipidus. Sucking on ice chips or sugar free candies to moisten your mouth and increase saliva flow may help reduce your thirst. If you wake up many times at night to urinate, your health care professional may suggest you take a small dose of desmopressin at bedtime. Your health care professional may also monitor your blood levels of sodium, which can drop too low if you have this condition. […] Health care professionals treat gestational diabetes insipidus with desmopressin, which is safe for both mother and baby. An expectant mother’s placenta does not destroy desmopressin as it does vasopressin. Gestational diabetes insipidus usually goes away after the baby is born, but may return if the mother becomes pregnant again. […] Most people with diabetes insipidus can prevent serious problems and live a normal life if they follow their health care professionals recommendations and keep their symptoms under control.

• #1 Get Diabetes Insipidus Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/diabetes-insipidus-treatment

  We treat gestational diabetes insipidus like central diabetes insipidus, with vasopressin or desmopressin. After pregnancy, the condition usually goes away on its own. […] Nephrogenic diabetes insipidus doesnt respond to hormone therapy. It happens because of how your kidneys use vasopressin rather than not having enough of it. To control how much pee your body makes, we usually recommend: Low-salt diet, Thiazide diuretics, Nonsteroidal anti-inflammatory drugs (NSAIDs). […] There isnt an effective treatment for dipsogenic diabetes insipidus. We may recommend a small dose of desmopressin at night if you wake up a lot to pee. And there are ways to control your thirst so that you dont urinate as often: Avoid alcohol, Cut out salty or spicy foods, Drink water, not sugary or caffeinated beverages, Get plenty of electrolytes. […] Diabetes insipidus is treatable. And it doesnt have to limit what you do or how you feel about yourself. Cleveland Clinic healthcare providers can help you learn how to manage lifestyle changes and medications so you can get back to enjoying life.

• #1 Diabetes Insipidus Treatment & Management: Approach Considerations, Postoperative Setting, Consultations

  https://emedicine.medscape.com/article/117648-treatment

  After pituitary surgery, patients should undergo continuous monitoring of fluid intake, urinary output, and specific gravities, along with daily measurements of serum electrolytes. In patients who develop DI, administer parenteral desmopressin every 12-24 hours, along with adequate fluid to match losses. […] In the setting of neurosurgery or head trauma, the diagnosis of DI may be obvious, and even expected. The intensivists and nurses who manage the patient acutely are in the best position to provide acute care. […] In the more subtle forms of DI, and certainly in all chronic forms of DI for which therapy is expected to be indefinite, the clinical endocrinologist is an invaluable aid in establishing the diagnosis and designing therapy.

• #1 Diabetes insipidus

  https://www.rch.org.au/clinicalguide/guideline_index/diabetes_insipidus/

  Children with suspected or known diabetes insipidus (DI) must always have free access to water. Never restrict fluid intake […] Desmopressin (DDAVP) is a long-acting analogue of ADH (will not treat complete nephrogenic DI) […] It is vital that access to water is never limited for children with suspected or confirmed DI, as their thirst response is what keeps serum sodium in the high normal range […] All children should be discussed with endocrinology before starting or modifying desmopressin treatment […] All children should be managed in conjunction with a paediatric nephrologist and dietician […] Rarely desmopressin may be considered in difficult, non-genetic cases as there may be a partial response […] Sodium chloride containing fluids must not be used for ongoing management without nephrology consultation due to risk of worsening hypernatraemic dehydration.

• #2

  https://www.nhs.uk/conditions/diabetes-insipidus/treatment/

  Treatments for diabetes insipidus aim to reduce the amount of urine your body produces. […] Depending on the type of diabetes insipidus you have, there are several ways of treating your condition and controlling your symptoms. […] As your condition is caused by a shortage of AVP, your GP or endocrinologist may prescribe a treatment that takes the place of AVP, known as desmopressin. […] Desmopressin is a manufactured version of AVP that’s more powerful and more resistant to being broken down than the AVP naturally produced by your body. […] Desmopressin can be taken as a nasal spray, in tablet form or as a form that melts in your mouth, between your gum and your lip. […] If you have more severe AVP-R, you may be prescribed a combination of thiazide diuretics and a non-steroidal anti-inflammatory drug (NSAID) to help reduce the amount of urine your kidneys produce. […] Thiazide diuretics can reduce the rate the kidneys filter blood, which reduces the amount of urine passed from the body over time. […] Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce urine volume further when they’re used in combination with thiazide diuretics.

• #2 Diabetes insipidus

  https://www.rch.org.au/clinicalguide/guideline_index/diabetes_insipidus/

  Children with suspected or known diabetes insipidus (DI) must always have free access to water. Never restrict fluid intake […] Desmopressin (DDAVP) is a long-acting analogue of ADH (will not treat complete nephrogenic DI) […] It is vital that access to water is never limited for children with suspected or confirmed DI, as their thirst response is what keeps serum sodium in the high normal range […] All children should be discussed with endocrinology before starting or modifying desmopressin treatment […] All children should be managed in conjunction with a paediatric nephrologist and dietician […] Rarely desmopressin may be considered in difficult, non-genetic cases as there may be a partial response […] Sodium chloride containing fluids must not be used for ongoing management without nephrology consultation due to risk of worsening hypernatraemic dehydration.

• #2 Diabetes Insipidus Treatment & Management: Approach Considerations, Postoperative Setting, Consultations

  https://emedicine.medscape.com/article/117648-treatment

  Most patients with diabetes insipidus (DI) can drink enough fluid to replace their urine losses. When oral intake is inadequate and hypernatremia is present, replace losses with dextrose and water or an intravenous (IV) fluid that is hypo-osmolar with respect to the patients serum. Do not administer sterile water without dextrose intravenously, as it can cause hemolysis. […] In patients with central DI, desmopressin is the drug of choice. A synthetic analogue of antidiuretic hormone (ADH), desmopressin is available in subcutaneous, IV, intranasal, and oral preparations. Generally, it can be administered 2-3 times per day. Patients may require hospitalization to establish fluid needs. Frequent electrolyte monitoring is recommended during the initial phase of treatment. […] Alternatives to desmopressin as pharmacologic therapy for DI include synthetic vasopressin and the nonhormonal agents chlorpropamide, carbamazepine, clofibrate (no longer on the US market), thiazides, and nonsteroidal anti-inflammatory drugs (NSAIDs). Because of side effects, carbamazepine is rarely used, being employed only when all other measures prove unsatisfactory. NSAIDs (eg, indomethacin) may be used in nephrogenic DI, but only when no better options exist.

• #2 Diabetes Insipidus: Diagnosis and Treatment

  https://www.massgeneral.org/children/diabetes/insipidus-diagnosis-treatment

  Central or neurogenic DI and nephrogenic DI are treated differently. […] We treat central or neurogenic DI by giving medication to provide the vasopressin effects that the body needs. This medication comes in 2 forms, which are: […] Vasopressin given as an injection. The effects of the vasopressin injection last for only a few minutes. […] As a medication called desmopressin. The effects of desmopressin last for 8-24 hours. Desmopressin can be given as a nasal sniff (a mist you sniff through your nose), a pill or an injection. It is usually given about 2 times a day. […] We can also help treat DI by making sure children drink fluids only when they are thirsty and not just because they want or like a drink. This will help prevent them from becoming overloaded with fluid. […] Sometimes, it can be difficult to treat babies with central DI with desmopressin because they need to take in so much fluid to get the nutrition they need. They often do better when they are treated with hydrochlorothiazide, given as a pill or liquid and a diluted (watered down), low-protein formula until they are mostly taking solid foods. Hydrochlorothiazide works on the kidneys to help hold onto the water your baby’s body needs.

• #2 Diabetes Insipidus: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetes-insipidus-pro

  As the primary problem is a hormone deficiency, physiological replacement with desmopressin is usually effective. This can be given orally, intranasally or parenterally. […] Mild cases of DI (urine output 3-4 litres/24 hours) can be managed by ingestion of water to quench thirst. […] It is essential to avoid chronic overdosage with desmopressin, which will cause hyponatraemia. […] Long-term management: Because of the risk of hyponatraemia, occasional (1- to 3-monthly) measurements of serum sodium are advised. […] Some endocrinologists recommend missing desmopressin treatment one day each week to avoid the development of hyponatraemia. […] If daily urine volume is 4 litres/24 hours and the patient does not have severe dehydration then definitive therapy is not always necessary. […] It is important for patients always to have access to drinking water and to drink enough to satiate their thirst.

• #2 Diabetes Insipidus Treatment & Management: Approach Considerations, Postoperative Setting, Consultations

  https://emedicine.medscape.com/article/117648-treatment

  In central DI, the primary problem is a hormone deficiency; therefore, physiologic replacement with desmopressin is usually effective. Use a nonhormonal drug for central DI if response is incomplete or desmopressin is too expensive. […] Monitor for fluid retention and hyponatremia during initial therapy. Follow the volume of water intake and the frequency and volume of urination, and inquire about thirst. Monitor serum sodium, 24-hour urinary volumes, and specific gravity. Request posthospitalization follow-up visits with the patient every 6-12 months. Patients with normal thirst mechanisms can usually self-regulate. […] No specific dietary considerations exist in chronic DI, but the patient should understand the importance of an adequate and balanced intake of salt and water. A low-protein, low-sodium diet can help to decrease urine output.

• #2 ArginineVasopressin Deficiency (Central Diabetes Insipidus) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/argininevasopressin-deficiency-central-diabetes-insipidus

  Arginine vasopressin deficiency can be treated with hormone replacement and treatment of any correctable cause. In the absence of appropriate management, permanent renal damage can result. […] Treatment is with desmopressin. Nonhormonal treatment includes use of diuretics (mainly thiazides) and vasopressin-releasing medications, such as chlorpropamide. […] Desmopressin, a synthetic analog of vasopressin with minimal vasoconstrictive properties, has prolonged antidiuretic activity, lasting for 12 to 24 hours in most patients, and may be administered intranasally, orally, subcutaneously, or intravenously. […] For each patient, the duration of action of a given dose must be established because variation among individuals is great. […] At least 3 groups of nonhormonal medications are useful in reducing polyuria: Diuretics, primarily thiazides; Vasopressin-releasing medications (eg, chlorpropamide, carbamazepine, clofibrate); Prostaglandin inhibitors. […] These medications have been particularly useful in partial arginine vasopressin deficiency and do not cause the adverse effects of exogenous vasopressin.

• #2 Get Diabetes Insipidus Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/diabetes-insipidus-treatment

  We treat gestational diabetes insipidus like central diabetes insipidus, with vasopressin or desmopressin. After pregnancy, the condition usually goes away on its own. […] Nephrogenic diabetes insipidus doesnt respond to hormone therapy. It happens because of how your kidneys use vasopressin rather than not having enough of it. To control how much pee your body makes, we usually recommend: Low-salt diet, Thiazide diuretics, Nonsteroidal anti-inflammatory drugs (NSAIDs). […] There isnt an effective treatment for dipsogenic diabetes insipidus. We may recommend a small dose of desmopressin at night if you wake up a lot to pee. And there are ways to control your thirst so that you dont urinate as often: Avoid alcohol, Cut out salty or spicy foods, Drink water, not sugary or caffeinated beverages, Get plenty of electrolytes. […] Diabetes insipidus is treatable. And it doesnt have to limit what you do or how you feel about yourself. Cleveland Clinic healthcare providers can help you learn how to manage lifestyle changes and medications so you can get back to enjoying life.

• #2 Diabetes Insipidus – NIDDK

  https://www.niddk.nih.gov/health-information/kidney-disease/diabetes-insipidus

  How do health care professionals treat diabetes insipidus? The main way to treat diabetes insipidus is to drink enough liquids to prevent dehydration. But doing so can disrupt your regular lifestyle, including your sleep. Your health care professional may refer you to a specialist, such as a nephrologist or an endocrinologist for more specific treatments. Other treatments vary by cause. […] Health care professionals most often treat central diabetes insipidus with a man-made hormone called desmopressin, which replaces the vasopressin your body is not making. You can take this medicine as a nasal spray, a pill, or a shot. […] In some cases, nephrogenic diabetes insipidus may go away after treating its cause. For example, switching medicines or taking steps to balance the amount of calcium or potassium in your body may be enough to resolve the problem. Your health care professional may also prescribe a class of diuretic medicines called thiazides to help reduce the amount of urine your kidneys make. Other treatments can include nonsteroidal anti-inflammatory drugs or other types of diuretics.

• #2 Diabetes Insipidus: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetes-insipidus-pro

  Correct any metabolic abnormality. […] Stop any drugs that may be causing the problem. […] High-dose DDAVP may be used with success in mild-to-moderate cases of nephrogenic DI. […] Combination treatment with a thiazide diuretic and a non-steroidal anti-inflammatory drug may be effective in reducing the volume of urine produced. […] Patients with nephrogenic DI undergoing surgery need careful multidisciplinary management with close attention to fluid regimens and DDAVP administration. […] Patients with genetic causes or severe nephrogenic DI may need to practise clean, intermittent catheterisation to reduce urinary tract back-pressure complications. […] DDAVP can worsen myocardial ischaemia in susceptible patients; there may be a need for nitrates/other anti-anginal medications.

• #2 Diabetes Insipidus – NIDDK

  https://www.niddk.nih.gov/health-information/kidney-disease/diabetes-insipidus

  Researchers haven’t found an effective way to treat dipsogenic diabetes insipidus. Sucking on ice chips or sugar free candies to moisten your mouth and increase saliva flow may help reduce your thirst. If you wake up many times at night to urinate, your health care professional may suggest you take a small dose of desmopressin at bedtime. Your health care professional may also monitor your blood levels of sodium, which can drop too low if you have this condition. […] Health care professionals treat gestational diabetes insipidus with desmopressin, which is safe for both mother and baby. An expectant mother’s placenta does not destroy desmopressin as it does vasopressin. Gestational diabetes insipidus usually goes away after the baby is born, but may return if the mother becomes pregnant again. […] Most people with diabetes insipidus can prevent serious problems and live a normal life if they follow their health care professionals recommendations and keep their symptoms under control.

• #2 Diabetes insipidus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/diagnosis-treatment/drc-20351274

  Because the kidneys don’t properly respond to ADH in this form of diabetes insipidus, desmopressin won’t help. Instead, your health care provider may advise you to eat a low-salt diet to lower the amount of urine your kidneys make. […] Treatment with hydrochlorothiazide (Microzide) may ease your symptoms. Although hydrochlorothiazide is a diuretic a type of medicine that causes the body to make more urine it can lower urine output for some people with nephrogenic diabetes insipidus. […] Treatment for gestational diabetes insipidus involves taking the manufactured hormone desmopressin. […] There is no specific treatment for this form of diabetes insipidus other than lowering the amount of fluids you drink. If the condition is related to a mental illness, treating that may ease symptoms.

• #2 Diabetes Insipidus Treatment & Management: Approach Considerations, Postoperative Setting, Consultations

  https://emedicine.medscape.com/article/117648-treatment

  After pituitary surgery, patients should undergo continuous monitoring of fluid intake, urinary output, and specific gravities, along with daily measurements of serum electrolytes. In patients who develop DI, administer parenteral desmopressin every 12-24 hours, along with adequate fluid to match losses. […] In the setting of neurosurgery or head trauma, the diagnosis of DI may be obvious, and even expected. The intensivists and nurses who manage the patient acutely are in the best position to provide acute care. […] In the more subtle forms of DI, and certainly in all chronic forms of DI for which therapy is expected to be indefinite, the clinical endocrinologist is an invaluable aid in establishing the diagnosis and designing therapy.

• #2 Diabetes Insipidus & Other Related Conditions | Histiocytosis Association

  https://histio.org/histiocytic-disorders/diabetes-insipidus-other-related-conditions/

  Diabetes insipidus is usually a permanent, lifelong condition and cannot be cured. However, the symptoms of constant thirst and urination can be well controlled with treatment with DDAVP, a synthetic kind of vasopressin, and which can restore quality of life can be restored. […] Diabetes insipidus can be corrected by giving a synthetic vasopressin called DDAVP, which works on the kidneys to help decrease the amount of urine made. A normal balance between water intake and urine output is usually quickly restored. Most patients receive DDAVP as a pill or spray into the nose. However, if this is not possible due to the age or condition of the patient, DDAVP can be given by injection. It may be given in the hospital, clinic, or home. The dosage and method of receiving this hormone will depend on each individual case and should be discussed with your physician. […] Fortunately, this treatment can be taken on trips, kept in the nurses office at school, and for other occasions when out of the home. Life-long treatment of diabetes insipidus is usually necessary.

• #2 Diabetes Insipidus in Children | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/diabetes-insipidus-children

  Treatment for diabetes insipidus will focus first on identifying the cause of the condition when possible. […] Treatment for the symptoms of central diabetes insipidus begins with establishing the cause. Symptomatic management may include: modified antidiuretic hormone medications, such as desmopressin (DDAVP), taken as a pill, injection or nasal spray; modifying the fluids that a child is receiving; diuretic medications. […] If nephrogenic diabetes insipidus is identified, referral to CHOP nephrologists (kidney specialists) is made. Treatment for this condition may include: anti-inflammatory medications; diuretics (water pills); stopping a medication, such as lithium, if it has been found to be a cause of the kidney problem. […] Treatment for both forms of diabetes insipidus also includes careful attention to fluid and sodium intake. Children and adolescents with diabetes insipidus need close monitoring to prevent dehydration and electrolyte imbalance.

• #3 Diabetes Insipidus Treatment & Management: Approach Considerations, Postoperative Setting, Consultations

  https://emedicine.medscape.com/article/117648-treatment

  After pituitary surgery, patients should undergo continuous monitoring of fluid intake, urinary output, and specific gravities, along with daily measurements of serum electrolytes. In patients who develop DI, administer parenteral desmopressin every 12-24 hours, along with adequate fluid to match losses. […] In the setting of neurosurgery or head trauma, the diagnosis of DI may be obvious, and even expected. The intensivists and nurses who manage the patient acutely are in the best position to provide acute care. […] In the more subtle forms of DI, and certainly in all chronic forms of DI for which therapy is expected to be indefinite, the clinical endocrinologist is an invaluable aid in establishing the diagnosis and designing therapy.

• #3

  https://www.nhs.uk/conditions/diabetes-insipidus/treatment/

  Treatments for diabetes insipidus aim to reduce the amount of urine your body produces. […] Depending on the type of diabetes insipidus you have, there are several ways of treating your condition and controlling your symptoms. […] As your condition is caused by a shortage of AVP, your GP or endocrinologist may prescribe a treatment that takes the place of AVP, known as desmopressin. […] Desmopressin is a manufactured version of AVP that’s more powerful and more resistant to being broken down than the AVP naturally produced by your body. […] Desmopressin can be taken as a nasal spray, in tablet form or as a form that melts in your mouth, between your gum and your lip. […] If you have more severe AVP-R, you may be prescribed a combination of thiazide diuretics and a non-steroidal anti-inflammatory drug (NSAID) to help reduce the amount of urine your kidneys produce. […] Thiazide diuretics can reduce the rate the kidneys filter blood, which reduces the amount of urine passed from the body over time. […] Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce urine volume further when they’re used in combination with thiazide diuretics.

• #3 Diabetes Insipidus (Arginine Vasopressin Deficiency) information | Society for Endocrinology

  https://www.endocrinology.org/clinical-practice/clinical-guidance/arginine-vasopressin-deficiency-diabetes-insipidus/diabetes-insipidus-arginine-vasopressin-deficiency-information/

  Diabetes insipidus is a rare but treatable chronic condition caused by the lack of the posterior pituitary hormone vasopressin (AVP, also known as anti-diuretic hormone) resulting in uncontrolled diuresis. It is treated with desmopressin (DDAVP, a synthetic AVP analogue) which reduces diuresis. […] Diabetes insipidus is treated with demopressin/DDAVP in the following doses: oral or sublingual – 100-200g (0.1-0.2mg), intranasal spray – 10=20g, IM or IV injection – 1-2g. […] Please note, in patients with decompensated diabetes insipidus fluid replacement should be the primary treatment with the aim of reducing hypernatraemia and 1-2ug IV or IM DDAVP administered with close attention paid to the clinical and biochemical response to prevent over-rapid overcorrection of hypernatraemia. […] Patients with diabetes insipidus who have a functioning thirst mechanism and are able to maintain their fluid intake through drinking should be identified on admission and allowed to continue their normal prescribed desmopressin/DDAVP.

• #3 ArginineVasopressin Deficiency (Central Diabetes Insipidus) – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/pituitary-disorders/argininevasopressin-deficiency-central-diabetes-insipidus

  Arginine vasopressin deficiency can be treated with hormone replacement and treatment of any correctable cause. In the absence of appropriate management, permanent renal damage can result. […] Treatment is with desmopressin. Nonhormonal treatment includes use of diuretics (mainly thiazides) and vasopressin-releasing medications, such as chlorpropamide. […] Desmopressin, a synthetic analog of vasopressin with minimal vasoconstrictive properties, has prolonged antidiuretic activity, lasting for 12 to 24 hours in most patients, and may be administered intranasally, orally, subcutaneously, or intravenously. […] For each patient, the duration of action of a given dose must be established because variation among individuals is great. […] At least 3 groups of nonhormonal medications are useful in reducing polyuria: Diuretics, primarily thiazides; Vasopressin-releasing medications (eg, chlorpropamide, carbamazepine, clofibrate); Prostaglandin inhibitors. […] These medications have been particularly useful in partial arginine vasopressin deficiency and do not cause the adverse effects of exogenous vasopressin.

• #3 Diabetes Insipidus: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetes-insipidus-pro

  As the primary problem is a hormone deficiency, physiological replacement with desmopressin is usually effective. This can be given orally, intranasally or parenterally. […] Mild cases of DI (urine output 3-4 litres/24 hours) can be managed by ingestion of water to quench thirst. […] It is essential to avoid chronic overdosage with desmopressin, which will cause hyponatraemia. […] Long-term management: Because of the risk of hyponatraemia, occasional (1- to 3-monthly) measurements of serum sodium are advised. […] Some endocrinologists recommend missing desmopressin treatment one day each week to avoid the development of hyponatraemia. […] If daily urine volume is 4 litres/24 hours and the patient does not have severe dehydration then definitive therapy is not always necessary. […] It is important for patients always to have access to drinking water and to drink enough to satiate their thirst.

• #3 Diabetes insipidus – Wikipedia

  https://en.wikipedia.org/wiki/Diabetes_insipidus

  Treatment involves drinking sufficient fluids to prevent dehydration. Other treatments depend on the type. In central and gestational DI treatment is with desmopressin. Nephrogenic DI may be treated by addressing the underlying cause or the use of a thiazide, aspirin, or ibuprofen. […] Central DI and gestational DI respond to desmopressin which is given as intranasal or oral tablets. Carbamazepine, an anticonvulsive medication, has also had some success in this type of DI. […] Desmopressin will be ineffective in nephrogenic DI which is treated by reversing the underlying cause (if possible) and replacing the free water deficit. A thiazide diuretic, such as chlorthalidone or hydrochlorothiazide, can be used to create mild hypovolemia which encourages salt and water uptake in proximal tubule and thus improve nephrogenic diabetes insipidus. Amiloride has additional benefit of blocking Na uptake. Thiazide diuretics are sometimes combined with amiloride to prevent hypokalemia caused by the thiazides.

• #3 Diabetes Insipidus Treatment & Management: Approach Considerations, Postoperative Setting, Consultations

  https://emedicine.medscape.com/article/117648-treatment

  Most patients with diabetes insipidus (DI) can drink enough fluid to replace their urine losses. When oral intake is inadequate and hypernatremia is present, replace losses with dextrose and water or an intravenous (IV) fluid that is hypo-osmolar with respect to the patients serum. Do not administer sterile water without dextrose intravenously, as it can cause hemolysis. […] In patients with central DI, desmopressin is the drug of choice. A synthetic analogue of antidiuretic hormone (ADH), desmopressin is available in subcutaneous, IV, intranasal, and oral preparations. Generally, it can be administered 2-3 times per day. Patients may require hospitalization to establish fluid needs. Frequent electrolyte monitoring is recommended during the initial phase of treatment. […] Alternatives to desmopressin as pharmacologic therapy for DI include synthetic vasopressin and the nonhormonal agents chlorpropamide, carbamazepine, clofibrate (no longer on the US market), thiazides, and nonsteroidal anti-inflammatory drugs (NSAIDs). Because of side effects, carbamazepine is rarely used, being employed only when all other measures prove unsatisfactory. NSAIDs (eg, indomethacin) may be used in nephrogenic DI, but only when no better options exist.

• #3 Diabetes insipidus

  https://www.rch.org.au/clinicalguide/guideline_index/diabetes_insipidus/

  Children with suspected or known diabetes insipidus (DI) must always have free access to water. Never restrict fluid intake […] Desmopressin (DDAVP) is a long-acting analogue of ADH (will not treat complete nephrogenic DI) […] It is vital that access to water is never limited for children with suspected or confirmed DI, as their thirst response is what keeps serum sodium in the high normal range […] All children should be discussed with endocrinology before starting or modifying desmopressin treatment […] All children should be managed in conjunction with a paediatric nephrologist and dietician […] Rarely desmopressin may be considered in difficult, non-genetic cases as there may be a partial response […] Sodium chloride containing fluids must not be used for ongoing management without nephrology consultation due to risk of worsening hypernatraemic dehydration.

• #4 Diabetes Insipidus: A Pragmatic Approach to Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7785480/

  Diabetes insipidus (DI) is a disorder of water balance characterized by polyuria and polydipsia. […] Management includes the correction of any water deficit and the use of specific pharmacological agents, including desmopressin, thiazides, and amiloride. […] Most cases of CDI can be effectively managed with vasopressin or its analogue, desmopressin. […] Treatment of the underlying cause of CDI and NDI is also important. […] Desmopressin is resistant to degradation by vasopressinase and has a greater anti-diuretic effect with 2000-fold lower vasopressor activity. […] Several other medications, including thiazide diuretics, carbamazepine, indomethacin, amiloride, etc., are available for the management of DI, especially NDI. […] Treatment of nephrogenic DI is usually with fluid replacement, reduced solute load, thiazides and indomethacin.

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