AQUEOUS VASOPRESSIN INFUSION DURING CHEMOTHERAPY IN PATIENTS WITH DIABETES-INSIPIDUS

Background. Patients who have suprasellar germinomas in childhood ofte n present with central diabetes insipidus (CDI). The authors investiga ted the use of aqueous vasopressin (AVP) by continuous infusion to con trol the fluid and electrolyte balance in germinoma patients with CDI during aggressive fluid hydration as a part of a preirradiation chemot herapy protocol. Methods. Three patients with suprasellar germinomas a nd CDI were treated with four courses of preirradiation chemotherapy. Two patients were treated with a continuous AVP infusion at an initial rate of 0.08-0.10 mU/kg per hour during hydration. Fluid intake, urin e output, body weight, urine specific gravity, and serum electrolyte c oncentrations were monitored closely, and the infusion rate was adjust ed accordingly. Results. Very low dose AVP infusion controlled fluid b alance while allowing appropriate diuresis during chemotherapy. Fluid intake and output were markedly less in the AVP-treated patients (3.8 L/m(2) per day) than in the untreated patient (20 L/m(2) per day). Con clusions. The use of very low dose AVP infusion at an initial rate of 0.08-0.10 mU/kg per hour during hydration therapy allowed easily titra table control of fluid and electrolyte balance in the patients studied and avoided the complications associated with desmopressin acetate an tidiuresis or withholding antidiuretic treatment altogether.