Management of diabetes insipidus

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Mild cases of cranial diabetes insipidus i.e. urine output less than 3-4 litres per 24 hr may be treated adequately by sufficient fluid intake.

Moderate / severe cases are treated with desmopressin 5-40 mcg intranasally. The lowest treatment dose that controls polyuria is used - the risk of hyponatraemia is increased with increasing dose of desmopressin.

• Symptoms of under-replacement with desmopressin are thirst and polyuria, while symptoms of over-replacement are headache and mild confusion (due to hyponatremia) and reduced urine output (1)

Other treatment options include:

Chlorpropamide 250-500 mg/day or carbamazepine 400-800 mg/day may be used to reduce urine volume by up to 50%

• chlorpropamide enhances the effects of ADH on the renal collecting tubule
• carbamazepine exerts its effects centrally

Familial cases of nephrogenic diabetes insipidus benefit from thiazide diuretics, indomethacin and high dose desmopressin, singly or in combination. Acquired cases require correction of the underlying abnormality.

References:

1. Levy M, Prentice M, Wass J. Diabetes insipidus. BMJ. 2019 Feb 28;364:l321. doi: 10.1136/bmj.l321.