Efficacy of Hydrochlorothiazide and low renal solute feed in Neonatal Central Diabetes Insipidus with transition to Oral Desmopressin in early infancy

Abstract

BackgroundThe treatment of central diabetes insipidus (DI) with desmopressin in the neonatal period is challenging because of the significant risk of hyponatremia with this agent. The fixed anti-diuresis action of desmopressin and the obligate high fluid intake with milk feeds lead to considerable risk of water intoxication and hyponatremia. To reduce this risk, thiazide diuretics, part of the treatment of nephrogenic DI, were used in conjunction with low renal solute feed and were effective in a single case series of neonatal central DI.Aim We evaluated the efficacy of early treatment of neonatal central DI with hydrochlorothiazide with low solute feed and investigated the clinical indicators for transition to desmopressin during infancy.MethodsA retrospective chart review was conducted at Princess Margaret Hospital, Perth of neonates diagnosed with central DI and treated with hydrochlorothiazide, between 2007 and 2013. Four newborns were identified. Mean sNa and mean change in sNa with desmopressin and hydrochlorothiazide treatment were recorded along with episodes of hyponatremia and hypernatremia. Length and weight trajectories during the first 12 months were assessed.ResultsThe mean change in sNa per day with hydrochlorothiazide and low renal solute feed was 2.5 - 3 mmol/L; on desmopressin treatment, the mean change in sNa was 6.8-7.9 mmol/L. There was one episode of symptomatic hyponatremia with intranasal desmopressin with no episodes of hyponatremia or hypernatremia during treatment with hydrochlorothiazide or following transition to oral desmopressin. Transition to oral desmopressin between 3 to 12 months of age was associated with good control of DI. Following introduction of solids, sNa remained stable but weight gain was slow. This improved following transition to desmopressin in one infant.ConclusionsHydrochlorothiazide with low renal solute feed is a safe and effective treatment option in neonatal central DI. However, transition to desmopressin should be considered early in infancy following initiation of solids to facilitate growth.

Thiazide Diuretics in the Management of Young Children with Central Diabetes Insipidus

“…The thiazide was stopped in 2 patients owing to the resolution of the DI. Both of these patients Regular formula with extra 1 oz of free water for every 5 oz of formula (given through a gastrostomy tube) 6 4 Low solute formula 7 6 Regular formula with extra 1 oz of free water for every 4 oz of formula 8 1 Low-solute formula 9 10 Breast milk, solid food, and free access to water 10 1 Low-solute formula 11 12 Regular formula mixed with fixed 36 oz of free water divided throughout the day (given through a gastrostomy tube)* 12…”

“…6,7 Thiazides, in combination with a low-solute formula, also have been used to treat infants and neonates with central DI, in an attempt to minimize the risk of hyponatremia associated with the use of vasopressin analogs. 8,9 Here we report our findings and outline the outcomes in a cohort of neonates, infants, and young children treated with thiazide diuretics for central DI. …”

Tratamiento con desmopresina sublingual en dos lactantes con hidranencefalia y diabetes insípida central

“…3,[14][15] La vía oral (preferentemente) y la nasal son las más utilizadas para el tratamiento de una DIC; la DS se ha comenzado a utilizar recientemente 1,[6][7][8][9][10][11][12][13] Episodios hiponatrémicos frecuentes, dificultades en la dosificación, técnica y patologías locales dificultan el uso nasal. 1,3,[5][6][7]15 La administración oral, aunque menos habitual, no está exenta de complicaciones hiponatrémicas, [5][6][7][8] sobre todo, cuando hay malformaciones cerebrales. 6 De acuerdo con la experiencia clínica, pareciera que la absorción de la DS por la mucosa bucal logra controles de natremia y diuresis más regulares que por otras vías.…”

Drugs for the treatment of central diabetes insipidus: historical background and modern opportunities

“…Тиазидные диуретики могут использоваться для ле-чения как центрального, так и нефрогенного несахар-ного диабета [1,33]. Данная группа препаратов влияет на дистальные извитые канальцы, ингибируя котран-спортировку натрия и хлоридов.…”

“…Данная группа препаратов влияет на дистальные извитые канальцы, ингибируя котран-спортировку натрия и хлоридов. При длительном влиянии снижается объем внеклеточной жидкости, что ведет к реабсорбции натрия и воды в проксималь-ных канальцах почек, и в итоге снижается количество выделяемой мочи [1]. Лечение несахарного диабета хлортиазидом по 5-10 мг/кг/сут или гидрохлортиази-дом (1-2 мг/кг/сут) у детей с ЦНД было эффективным и безопасным, госпитализация по поводу гипернатри-емии потребовалась 1/13 пациентов [40].…”