Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone in Critically Ill Patients

Abstract

Diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion lie at opposite ends of the spectrum of disordered renal handling of water. Whereas renal retention of water insidiously causes hypotonic hyponatremia in syndrome of inappropriate antidiuretic hormone secretion, diabetes insipidus may lead to free water loss, hypernatremia, and volume depletion. Hypernatremia and hyponatremia are associated with worse outcomes and longer intensive care stays. Moreover, pathologies causing polyuria and hyponatremia in patients in intensive care may be multiple, making diagnosis challenging. We provide an approach to the diagnosis and management of these conditions in intensive care patients.

Keywords: Desmopressin; Diabetes insipidus; Fluid restriction; Hypernatremia; Hyponatremia; Oral urea; Syndrome of inappropriate antidiuretic hormone (SIADH); Vaptans.