MANAGEMENT OF POSTOPERATIVE AND POSTTRAUMATIC DIABETES-INSIPIDUS IN CHILDREN

Endocrinologists are increasingly confronted by central diabetes insip idus (DI) in children who have had neurosurgical procedures or head in juries. The severity of the disorder depends on the anatomic level of the injury, the degree of hypothalamic pituitary gland damage, and the number and distribution of residual magnocellular neurons that secret e vasopressin. The course of DI may be transient or permanent. The ''t riphasic'' pattern is the most complex and potentially the most danger ous, because the diagnosis can be delayed or even missed. Before diagn osing DI, it is important to evaluate all of the other possible causes of postoperative and post traumatic polyuria, including fluid overloa d, osmotic diuresis, hyperglycemia, hypokalemia, and hypercalcemia. Th e treatment of DI is especially difficult when consciousness is impair ed, the thirst mechanism is not intact, or the child is very young. In the patient without an intact thirst mechanism, a daily fluid prescri ption and frequent checks on serum sodium levels are needed for approp riate home therapy. 1-Desamino-8-D-arginine vasopressin is the preferr ed antidiuretic agent, with the subcutaneous route suggested by us in children younger than 3 years. This article focuses on the pathophysio logy, presentation, and diagnosis of postoperative and post-traumatic DI and suggests guidelines for the management of this condition in chi ldren.