Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study

Abstract

Context and objective: Patients with cranial diabetes insipidus (CDI) are at risk of developing both hypernatraemia and hyponatraemia, due to the condition itself or secondary to treatment with vasopressin-analogues or during administration of i.v. fluids. We aimed to assess the frequency and impact of dysnatraemias in the inpatient (INPT) and outpatient (OPT) setting in desmopressin-treated CDI, comparing those with normal thirst with those with abnormal thirst. Design: The study included 192 patients with cranial diabetes, who were identified from the Beaumont Pituitary Database, a tertiary referral centre. Retrospective case note audit was performed and the clinical and biochemical information of 147 patients with CDI were available for analysis. Results: A total of 4142 plasma sodium measurements for 137 patients with normal thirst, and 385 plasma sodium measurements for ten patients with abnormal thirst were analysed. In those with normal thirst, the most common OPT abnormality was mild hyponatraemia (pNa C 131-134 mmol/l) in 27%, while 14.6% had more significant hyponatraemia (pNa C %130 mmol/l). Of those patients with normal thirst, 5.8% were admitted due to complications directly related to hyponatraemia. Compared with patients with normal thirst, those with abnormal thirst were more likely to develop significant OPT hypernatraemia (20% vs 1.4%, PZ0.02) and significant INPT hyponatraemia (50% vs 11.1%, P 0.02). Conclusion: OPT management of CDI is complicated by a significant incidence of hyponatraemia. In contrast, OPT hypernatraemia is almost exclusively a complication seen in adipsic CDI, who also had more frequent INPT hyponatraemia. CDI associated with thirst disorder requires increased physician attention and patient awareness of potential complications.

Diagnosis and management of central diabetes insipidus in adults

“…The risk of hyponatraemia was higher in patients with more severe DI, who needed higher doses of regular dDAVP 50. In patients with mild CDI, a starting dose of 100-200 μg orally at night is often sufficient to control nocturia.…”

“…ficiency. In Behan's study, patients with abnormal thirst were much more likely to develop significant hypernatraemia as out-patients, when compared to patients with intact thirst appreciation (20% vs 1.4%, P = 0.02) 50. The dose may be titrated until symptom control is achieved; severe disease may require up to 200 μg two to three times daily.analogues are non-suppressible.…”

“…Further doses are administered only if polyuria recurs.Rarely, a triphasic response can occur, in which initial DI is followed by an antidiuresis and hyponatraemia, with a subsequent return to permanent DI. For this reason, and due to the fact that CDI is often The risk of hyponatraemia was higher in patients with more severe DI, who needed higher doses of regular dDAVP 50. Chronic hyponatraemia is associated with unsteady gait, falls, fractures, and increased mortality, 51 so the maintenance of normal plasma sodium concentrations is important.…”

ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of diabetes insipidus and hyponatraemia

“…To reduce the symptoms of polyuria and polydipsia, desmopressin is given orally or intranasally; the major complication of desmopressin therapy is hyponatraemia. A retrospective review has shown that 27% of central DI patients show mild hyponatremia (131-134 mmol/L) on routine electrolyte testing and 15% develop more severe hyponatraemia (≤130 mmol/L), over long-term follow-up 10 . Hyponatraemia develops when the antidiuretic effects of continuous desmopressin therapy prevent free water excretion, even with normal fluid intakes.…”

“…-Epidemiological data show that hypernatraemia is rare in ambulatory patients with DI; in contrast, the rate of hypernatraemia during hospital admission is significant 10 . The aetiology of this hypernatraemia is multifactorial; if cognition is attenuated by critical illness, fluid intake may be reduced, and if the patient is vomiting, oral desmopressin intake may be difficult.…”