1/9. Cerebral oedema in enuretic children during low-dose desmopressin treatment: a preventable complication.Seven cases of cerebral oedema have been observed in enuretic children during low-dose desmopressin (DDAVP) treatment given in a dose of 7-21 microg daily in the czech republic between 1995 and 1999, after the drug started to be marketed for this indication and delivered in simple bottles with a dropper. All seven children (age 5-11 years, four boys) experienced a period of unconsciousness but all recovered without sequelae. In most cases, safety measures were underestimated and natraemia was not regularly controlled. Two children developed cerebral oedema after excessive water intake in preparation for uroflowmetry, another one drank much during a hot summer day, in one diabetes insipidus was not recognised and two children were clearly non-compliant with reduced fluid intake on a long-term basis. Only in one child, no risk factor was found. Conclusion. Proper selection and instruction of patients is needed to avert cerebral oedema during treatment with desmopressin for nocturnal enuresis.- - - - - - - - - - ranking = 1keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
2/9. Behavioral and medical treatment of chronic polydipsia in a patient with schizophrenia and diabetes insipidus.OBJECTIVE: This case report describes a novel outpatient behavioral treatment intervention for chronic polydipsia. The program was used in an effort to reduce excessive fluid intake in a woman with chronic paranoid-type schizophrenia who also had a diagnosis of diabetes insipidus. methods: The 12-session individual behavioral intervention incorporated self-monitoring, stimulus control, coping skills training, and reinforcement components. RESULTS: The patient engaged fully in the treatment program, and she successfully restricted her fluid intake. Her diabetes insipidus could therefore be treated with desmopressin, a medication that requires fluid restriction, and she experienced a concomitant reduction in polyuria and urinary incontinence. CONCLUSIONS: The outpatient behavioral intervention demonstrated promising outcomes in a chronically mentally ill patient whose polydipsia had underlying psychogenic and physiological components. This case highlights the efficacy of combining behavioral and medical interventions.- - - - - - - - - - ranking = 6keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
3/9. Acute water intoxication after intranasal desmopressin in a patient with primary polydispsia.Only a few cases of severe acute water intoxication (AWI) due to intranasal desmopressin have been reported, none of which occurred in patients with primary polydipsia. We describe a case of AWI with semicoma and convulsions, due to intranasal desmopressin, in a 32-year-old patient with dipsogenic diabetes insipidus. Previous reported cases of AWI due to desmopressin are discussed. The importance of ruling out primary polydipsia when this drug is used, not only for central diabetes insipidus but also for other current indications such as classic hemophilia, is stressed.- - - - - - - - - - ranking = 2keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
4/9. Coexisting central diabetes insipidus and psychogenic polydipsia.A chronic schizophrenic patient is described in whom central diabetes insipidus and psychogenic polydipsia coexisted. A possible relationship between psychogenic polydipsia and failure of vasopressin release is hypothesized.- - - - - - - - - - ranking = 5keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
5/9. water intoxication associated with nephrogenic diabetes insipidus secondary to lithium: case report.In the psychiatric population, psychogenic polydipsia leading to water intoxication and nephrogenic diabetes insipidus secondary to lithium therapy are both well-recognized entities. A case is reported of the apparently unusual combination of these two conditions, where lithium probably not only has caused the nephrogenic diabetes insipidus, but might also have contributed to the state of psychogenic polydipsia.- - - - - - - - - - ranking = 6keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
6/9. Unstable osmoreceptors and defective thirst in hypothalamic hypopituitarism.An 8-year-old girl with hypothalamic hypopituitarism is described. The clinical course was characterized by fluctuation between diabetes insipidus and water intoxication. In an attempt to find a physiological explanation she underwent two sets of dehydration and osmotic threshold tests. The presence of endogenous vasopressin, and the normally functioning volume receptors, was demonstrated by the normal urine osmolality during dehydration. The osmotic threshold was 263 mosm/kg on one test and 300 mosm/kg on the other. More extreme values might be suspected based on simultaneous urine and plasma osmolality obtained during acute episodes of water intoxication and severe dehydration. With plasma osmolality as high as 307 mosm/kg, the child denied thirst. The data appear to indicate an instability of the osmoreceptor mechanism and a deficiency of the thirst mechanism with intact volume receptors.- - - - - - - - - - ranking = 1keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
7/9. Intranasal desmopressin-induced hyponatremia.Desmopressin is a commonly used, well-tolerated agent for the treatment of primary nocturnal enuresis and central diabetes insipidus. Intranasal desmopressin provides symptomatic relief with few serious complications. A 29-year-old woman with a long history of primary nocturnal enuresis began treatment with intranasal desmopressin. Although the enuresis ceased, she developed throbbing headaches, nausea, vomiting, paresthesia, lethargy, fatigue, and altered mental status over the next 7 days. When she came to the emergency room her sodium concentration was 127 mmol/L. The history of desmopressin use was not obtained at that time. She was treated with intravenous fluids and discharged. The symptoms returned and worsened over the next 4 days, and she returned to the emergency room stuporous. A repeat sodium was 124 mmol/L, and she was admitted. The history of desmopressin use was still not available. Medical evaluations included computerized tomography, lumbar puncture, complete blood counts, serum chemistries, and serologies. The next morning the woman was improved and informed clinicians of her desmopressin use. Without other causes for the hyponatremia, she was diagnosed with the syndrome of inappropriate antidiuretic hormone, presumably caused by desmopressin. Within 24 hours of fluid restriction and cessation of desmopressin, her symptoms and hyponatremia resolved. A review of the literature found 11 children and 2 adults in whom intranasal desmopressin was associated with hyponatremia, all of whom experienced seizures or altered mental status. Our patient illustrates the importance of early recognition and treatment of hyponatremia before the onset of seizures. When vague symptoms develop during desmopressin therapy, hyponatremia must be considered as part of the differential diagnosis. It may also be prudent to screen for electrolyte abnormalities in patients taking this agent to prevent serious iatrogenic complications.- - - - - - - - - - ranking = 1keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
8/9. Self-induced water intoxication in a schizophrenic patient.water intoxication occurred in a 53-year-old woman with chronic simple schizophrenia and poorly controlled diabetes. For several years she had had a compulsive habit of drinking excessive amounts of water. coma, fever, convulsions and other neurologic signs appeared suddenly, and she had severe hyponatremia. Her condition improved rapidly when the electrolyte abnormality was corrected.- - - - - - - - - - ranking = 0.005268365589204keywords = diabetes (Clic here for more details about this article) |
9/9. diabetes insipidus and polydipsia in a patient with Asperger's disorder and an empty sella: a case report.The paper describes a patient with Asperger disorder, Neurogenic diabetes insipidus (NDI) and Primary Empty Sella (ES). His response to vasopressin treatment suggested a concomitant presence of primary polydipsia. This is the first reported case of an autistic spectrum disorder associated with NDI or ES. The implications of the observed co-occurrence of these relatively rare disorders are discussed in relation to diagnosis and pathogenesis.- - - - - - - - - - ranking = 0.78877809443249keywords = insipidus (Clic here for more details about this article) |