Transient Diabetes Insipidus After Discontinuation of Therapeutic Vasopressin

Abstract

The use of vasopressin for the treatment of septic shock is increasing. Few reports of fluid and electrolyte complications of this therapy have been reported. A neurologically impaired, 53-year-old man with a history of syndrome of inappropriate antidiuretic hormone developed apparent transient diabetes insipidus and acute hypernatremia after being treated with vasopressin. He was treated for presumed septic shock with intravenous vasopressin 0.01-0.10 U/minute. His blood pressure did not improve with this therapy, and his course was complicated by hyponatremia during the vasopressin infusion. Discontinuation of the infusion was followed by a profound (8.4 L) diuresis and rapid onset of hypernatremia (serum sodium concentration increased from 132 to 157 mEq/L over 8 hrs). Although urine osmolality was not measured during the patient's diuresis, the rapid changes in serum sodium concentration can be explained only by an inappropriate water diuresis. The diuresis ceased when the vasopressin infusion was resumed. We concluded that these findings are most consistent with transient diabetes insipidus. The safety and efficacy of intravenous vasopressin have not been established in patients with septic shock and underlying disorders of water homeostasis. The drug may have diminished vasoconstrictive effects in this patient population. Careful monitoring of water and sodium balance is warranted in all patients treated with vasopressin for septic shock.

Protracted Acute Hypervolemic Hypernatremia Unmasked After Vasopressin Therapy: Case Report, Literature Review, and Proposed Algorithmic Approach

“…Hypernatremia after withdrawal of vasopressin therapy has been reported to occur in up to 3% of intensive care patients and has been typically ascribed to transient DI after withdrawal of vasopressin therapy (3)(4)(5). Traditionally DI refers to the euvolemic or hypovolemic state.…”

Diabetes insipidus after discontinuation of vasopressin infusion for septic shock

“…Despite the widespread use of vasopressin for blood pressure maintenance in patients with septic shock and in other populations, very few cases of DI following the discontinuation of vasopressin infusion have been reported. A literature review revealed that to date, 5 reports, describing a total of 11 patients, have been published . The actual incidence of vasopressin‐associated DI is unknown.…”

“…A literature review revealed that to date, 5 reports, describing a total of 11 patients, have been published. [6][7][8][9][10] The actual incidence of vasopressin-associated DI is unknown. We herein describe a patient with multiple episodes of DI following the discontinuation of vasopressin infusion for septic shock and review the extant literature.…”

“…Indeed, a literature search revealed only 5 publications (2 of which are abstracts) describing 11 patients with this syndrome. [6][7][8][9][10] Thus, one might conclude that this is a very rare occurrence. On the other hand, the most recent publication describes 6 neurosurgical patients from one institution identified within a 4-year period, 10 suggesting that this phenomenon may not be as rare as the dearth of published reports would indicate.…”

“…Horizontal lines indicate the times of continuous . Indeed, the duration of vasopressin infusion in the 11 previously reported patients ranged from 15 hours to 5 days,with the majority of patients receiving continuous infusion for greater than 24 hours [6][7][8][9][10]. What predisposes an apparently small subgroup of patients receiving vasopressin infusion to develop DI upon its discontinuation remains unknown.…”