Diuretics for diabetes insipidus

Abstract

The concept of using diuretics for a patient with diabetes insipidus (DI) seems counterintuitive. However, thiazides have been very useful in the management of children with nephrogenic DI for quite some time. In that condition, their effect is somewhat unclear, but by inducing mild volume contraction, they may reduce distal nephron delivery of salt and water, leading to a decrease in urine output. Although the underlying defect in central DI is obviously very different from that of nephrogenic DI, the clinical presentation and electrolyte physiology is similar. In older children and adults, the use of vasopressin analogues (such as desmopressin [DDAVP]) is the standard therapy for central DI. This approach is fraught with difficulty in infants, however. Given that most of their intake is liquid, symptomatic hyponatremia is a frequent complication when infants with central DI are treated with DDAVP. In light of the efficacy of thiazides in nephrogenic DI, many have employed them for infants with central DI, in place of DDAVP. There is, however, very little published information on this approach. The current issue of The Journal includes a single-center report of 13 children with central DI treated with thiazides from the Mayo Clinic. In general, this approach worked very well in these children. In particular, complications requiring hospital admission were very rare. The article provides quite a bit of detail to guide clinicians wanting to use this approach. Article page 658▶ Thiazide Diuretics in the Management of Young Children with Central Diabetes InsipidusThe Journal of PediatricsVol. 167Issue 3PreviewTo report our experience in treating infants and toddlers with central diabetes insipidus (DI) with thiazide diuretics. Full-Text PDF