Management of Arginine Vasopressin Deficiency (Central Diabetes Insipidus) in Neonates and Infants

Abstract

Background: Arginine vasopressin deficiency (AVP-D), previously called central diabetes insipidus (central DI), is the inability to concentrate urine despite elevated serum osmolality (i.e., volume depletion) related to inadequate production of the posterior pituitary hormone vasopressin. Without treatment, which typically consists of fluids and pharmacologic vasopressin analogs, AVP-D can quickly lead to hypernatremia and dehydration. Management of AVP-D in neonates and infants is particularly challenging for many reasons: their inability to communicate thirst, their limited renal concentrating capacity, the obligate fluids required for nutrition that may cause hyponatremia with anti-diuretic therapy, the lack of FDA-approved formulation of vasopressin analog in this age, the potential need for growth-related adjustments in nutrition, fluids, and vasopressin analogs, and a limited evidence base. Despite these challenges, multiple groups have reported experiences with the available pharmacologic options, including alternative formulations of desmopressin (buccal, standard oral tablet, orally disintegrating tablet [melt], subcutaneous) and thiazide diuretics.

Summary: The objective of this mini-review was to provide pragmatic guidance on the options for long-term outpatient management of AVP-D in neonates and infants.

Key messages: Management of AVP-D in neonates and infants necessitates special considerations. For each affected patient and family, weighing the relative merits and drawbacks of each approach is critical to identify the most appropriate option, which may also change over time.

Keywords: Arginine vasopressin deficiency/central diabetes insipidus; Desmopressin; Hypernatremia; Hyponatremia; Vasopressin.