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Department of Emergency Medicine


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Category: Critical Care

Title: Diabetes Insipidus in the Critically Ill


Posted: 5/3/2010 by Evadne Marcolini, MD (Emailed: 5/4/2010)
Click here to contact Evadne Marcolini, MD

In the ICU, diabetes insipidus (DI) develops in patients with pituitary surgery, brain trauma,
intracranial hypertension and brain death.  Criteria include the following:

urine output >200 ml/hr or 3 ml/kg/hr


urine osmolality <150 mOsm/kg
serum sodium>145 mEq/L
urine specific gravity<1.005

In the ICU, patients are typically unable to consume free water to compensate for urinary losses, and
dehydration, hypotension and hypernatremia occur.  Clinical signs may not appear until sodium levels
surpass 155-160 mEq/L or serum osmolality surpsses 330 mOsm/kg. 

Symptoms include confusion, lethargy, coma, seizures and cerebral shrinkage associated with
subdural or intraparenchymal hemorrhage. 

Treatment includes

controlling polyuria with vasopressin (antidiuretic, vasoconstrictive e ects) and desmopressin


(DDAVP - antidiuretic e ect)
calculate and replace free water loss
TBW deficit (L) = body weight (kg) x 0.6 x (Na-140)/Na
monitor and replace urine losses hourly (using gastric access if possible)
monitor serum sodium and adjust therapy every 4 hours closely monitor for hyperglycemia and
treat to prevent osmotic diuresis due to glucosuria

References
Fink MP, Abraham E, Vincent JL, Kochanek PM, eds. Textbook of Critical Care. 5th ed. Philadelphia, PA:
Elsevier/Saunders; 2005.

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