Sudden Vasopressin Withdrawal Causing Transient Central Diabetes Insipidus: A Case Report

Abstract

Vasopressin is a peptide hormone produced by the hypothalamus and stored in the posterior pituitary. It is secreted in response to hypotension and hyperosmolarity. Vasopressin and its analogs have been widely used in vasodilatory shocks such as septic shock and cardiogenic shock. The sudden withdrawal of vasopressin after its prolonged use can lead to polyuria and rising sodium levels, which is concerning for the diagnosis of diabetic insipidus (DI); likely central rather than nephrogenic in origin. We present a case of diabetic insipidus following the sudden discontinuation of a prolonged vasopressin infusion for septic shock, which responded to tapering doses of desmopressin.

Transient diabetes insipidus in critically ill COVID19 patients

“…Two describe critical COVID19 patients treated with VV-ECMO who were diagnosed with DI. Only one of these cases is similar to our description – a VV-ECMO patient who was weaned from vasopressin a day before polyuria appeared [ 30 ]. The other descriptions are of a patient who was not treated with vasopressin [ 31 , 32 ]; a non-ECMO COVID-19 patient who developed central DI with brain edema [ 33 ]; and an ECMO patient who developed oliguria and hyponatremia while treated with vasopressin [ 34 ].…”

Transient Diabetes Insipidus After Vasopressin Discontinuation

“…Outside of the classic neuro-ICU patient population, there was one recent report of this tDI phenomenon occurring in a medical ICU patient: a 52-year-old man with COVID-19-related acute respiratory distress syndrome required initiation of veno-venous extracorporeal membrane oxygenation and infusion of vasopressors, including vasopressin, for treatment of shock. The continuous use of vasopressin over the course of five days in this patient was thought to have inadvertently shut off the antidiuretic hormone production in the hypothalamus and thus disrupted the hypothalamic-pituitary axis and transport of ADH to the kidneys [ 13 ].…”

“…tDI is more common in these patients due to direct injury to the hypothalamus, pituitary gland, or blood supply [ 11 , 12 ]. To date, there have been few case reports describing this phenomenon in patients without any underlying neurological pathologies [ 10 , 13 ]. Here, we present the case of tDI in a patient following the discontinuation of vasopressin for treatment of septic shock after an emergent surgical airway procedure.…”