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Case Reports
. 2015 Feb;133(1):60-3.
doi: 10.1590/1516-3180.2012.6450001. Epub 2014 Sep 26.

Central diabetes insipidus: alert for dehydration in very low birth weight infants during the neonatal period. A case report

Maria Lúcia Silveira Ferlin  1 , Débora Simone Sales  2 , Fábia Pereira Martins Celini  2 , Carlos Eduardo Martinelli Junior  1
Affiliations
Case Reports

Central diabetes insipidus: alert for dehydration in very low birth weight infants during the neonatal period. A case report

Maria Lúcia Silveira Ferlin et al. Sao Paulo Med J. 2015 Feb.

Abstract
in English, Portuguese

Context: Central diabetes insipidus (CDI) is a rare cause of hypernatremia during the neonatal period. The diagnosis is particularly difficult in very low birth weight (VLBW) newborns.

Case report: We report on a preterm newborn who presented CDI soon after birth. On the third day of life, signs of dehydration were present despite normal fluid supply. The diuresis rate was 4.4 ml/kg/h. Although the fluid supply was then increased, the dehydration continued, with hypernatremia, normal glycemia, diuresis of 7.4 ml/kg/h and urine density of 1005 mOsmol/l. Thus, a diagnostic hypothesis of diabetes insipidus was raised. A test with a nasal vasopressin analogue (dDAVP) was performed and CDI was confirmed. Reduction of the fluid supply became possible through appropriate treatment.

Conclusion: The diagnosis of CDI is rarely made during the neonatal period, especially in VLBW newborns, because of the difficulty in detecting elevated diuresis. Persistent hypernatremia, usually accompanied by hyperthermia despite abundant fluid supply, weight loss and low urine osmolality are important signs of alert.

CONTEXTO:: Diabete insípido central (DIC) é uma rara causa de hipernatremia durante o período neonatal. O diagnóstico é difícil, particularmente em recém-nascidos (RN) de muito baixo peso (RNMBP).

RELATO DE CASO:: Relatamos um RN que apresentou DIC logo após o nascimento. No terceiro dia de vida, apresentava sinais de desidratação, embora estivesse recebendo aporte adequado de líquidos. A diurese aferida era de 4,4 ml/kg/h. Apesar do aumento do aporte hídrico, manteve-se desidratado, com hipernatremia, valores normais de glicemia e diurese de 7,4 ml/kg/h com densidade urinária de 1005 mOsmol/l. Desta forma, a hipótese diagnóstica de diabete insípido foi considerada. O teste com análogo da vasopressina (dDAVP) foi realizado e DIC foi confirmado. A redução do aporte de líquidos foi possível com o tratamento adequado.

CONCLUSÃO:: O diagnóstico de DIC raramente é realizado durante o período neonatal, particularmente em RNMBP, devido à dificuldade em detectar diurese aumentada. Hipernatremia persistente, geralmente acompanhada de hipertermia, apesar do abundante aporte de água, perda de peso e osmolaridade urinaria baixa, são importantes sinais de alerta.

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Conflict of interest statement

Conflict of interest: None

Figures

Table 1.
Table 1.. Serum sodium (Na+) and potassium (K+) concentrations, plasma osmolality (Posm), urinary osmolality (Uosm), glycemia (mg%), fluid supply (ml/kg/day), diuresis (ml/kg/hour) and weight (g) before (pre) and 8 and 20 hours after (post) administration of 0.012 ml dDAVP (1-deamino-8-D-arginine vasopressin)
Table 2.
Table 2.. Search strategies performed on August 28, 2013, and results from Medline (Medical Literature Analysis and Retrieval System Online), Lilacs (Literatura Latino Americana e do Caribe em Ciências da Saúde) and IBECS (Índice Bibliográfico Espanhol em Ciências da Saúde)
See this image and copyright information in PMC

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