Central Diabetes Insipidus Accompanying Brain Death in Children

Abstract

Introduction Brain death is currently defined as the loss of full brain function including the brainstem. The diagnosis and its subsequent management in the pediatric population are still controversial. The aim of this study was to define the demographic characteristics, clinical features and outcomes of patients with brain death and determine the incidence of central diabetes insipidus accompanying brain death in children. Methods This retrospective study was conducted at a 12-bed tertiary-care combined medical and surgical pediatric intensive care unit of a university hospital. Results In 37 of 341 deaths (10.8%), the diagnosis of brain death was identified. The primary insult causing brain death was hypoxic-ischaemic brain injury in 12 (32.4%), traumatic brain injury in 8 (21.6%), intracranial lesions in 7 (18.9%). In all patients, transcranial doppler ultrasound was utilized as an ancillary test. In 33 (89%) patients, central diabetes insipidus was determined at or near the time brain death was confirmed. The consent rate for organ donation was 18.9%, and 16.7% of potential donors proceeded to actual donation. Conclusion The prevalence of central diabetes insipidus in our pedaitric brain death population is higher than reports in literature and acute renal failure accounted for the lack of central diabetes insipidus in 4 patients with brain death. We believe that the persistence of cerebral blood flow after brain death may result in normouria in at least some patients. Futher studies are needed to explain normouria in brain death patients.