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Central diabetes insipidus

Key sources
The following summarized guidelines for the evaluation and management of central diabetes insipidus are prepared by our editorial team based on guidelines from the Histiocyte Society (HS 2022), the American College of Radiology (ACR 2019), the Society for Endocrinology (SE 2018), the European Thyroid Association (ETA 2018), and the Endocrine Society (ES 2016).
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Guidelines

1.Diagnostic investigations

Initial evaluation: obtain an urgent clinical assessment of volume and hydration status and measurement of serum sodium, potassium, and renal function.
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  • Diagnostic imaging

  • Evaluation for hypopituitarism (central adrenal insufficiency)

  • Evaluation for hypopituitarism (central hypothyroidism)

2.Medical management

Setting of care
Discuss cases of hospitalized patients with central diabetes insipidus with the endocrine team as soon as possible to ensure optimal inpatient care and specialist follow-up thereafter.
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Manage patients with hypernatremia as a medical emergency with a level 2-3 care or equivalent high dependency setting.
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  • Treatment goals

  • Fluid therapy

  • Desmopressin

  • Vasopressin

3.Inpatient care

Serial clinical and laboratory assessment: as per SE 2018 guidelines, obtain serum sodium monitoring in able patients at least every 24 hours while on IV fluids to avoid the occult development of hyponatremia in patients requiring maintenance IV fluid therapy and taking regular desmopressin.
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4.Specific circumstances

Pregnant patients: consider continuing desmopressin during pregnancy and adjusting doses if required in pregnant patients with preexisting diabetes insipidus.
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  • Patients with Langerhans cell histiocytosis

  • Patients with adrenal insufficiency

5.Quality improvement

Medical alert bracelet: consider ensuring that all patients with diabetes insipidus wear an emergency bracelet or necklace to inform clinicians of their condition if incapacitated.
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  • Hospital requirements