Management of early postoperative diabetes insipidus with parenteral desmopressin

• Published in: Acta endocrinologica (Copenhagen) Vol. 117; no. 4; pp. 513 - 516
• Main Authors: Chanson, P, Jedynak, C P, Czernichow, P
• Format: Journal Article
• Language: English
• Published: Denmark 01.04.1988
• Subjects: Adolescent; Adult; Clinical Trials as Topic; Deamino Arginine Vasopressin - administration & dosage; Diabetes Insipidus - drug therapy; Diabetes Insipidus - etiology; Female; Humans; Injections, Intravenous; Male; Middle Aged; Osmolar Concentration; Postoperative Complications - drug therapy
• ISSN: 0804-4643; 0001-5598; 1479-683X
• DOI: 10.1530/acta.0.1170513

Management of early postneurosurgical diabetes insipidus (DI) requires parenteral vasopressin before intranasal administration of desmopressin-1 desamino-8 D arginine vasopressin (dDAVP) can be initiated. We have evaluated in 15 neurosurgical patients the effect and the tolerance of a 3-day regimen of dDAVP administered im every 12 h. Patients were randomly ascribed to one of 3 treatment groups: 1 μg (N = 6), 2 μg (N = 5) or 4 μg (N = 4) were administered twice daily. dDAVP was effective whatever the dose, and DI was corrected by the 6th h of treatment. Effects were maximal on diuresis and urinary osmolality from the 18th h onwards. The effects were sustained throughout the treatment period. Reversal to pretreatment status occurred 24 h after the last injection. Moreover, 72 h after the last injection, natremia and osmolality reached values significantly below pretherapeutic values. The tolerance was excellent: hyponatremia which occurred in 11 patients, either occasionally or throughout the treatment period, remained mild and never had clinical consequences. In conclusion, before initiation of intranasal dDAVP, a 3-day treatment by 1, 2 or 4 μg of dDAVP injected im twice daily in neurosurgical patients corrected DI. Mild overhydration owing to a positive fluid balance was a side-effect which is also encountered in other therapeutic methods necessitating meticulous control of water intake.