DIAGNOSIS AND MANAGEMENT ALGORITHM OF ACUTE ONSET OF CENTRAL DIABETES-INSIPIDUS IN CRITICALLY ILL CHILDREN

We devised a diagnosis and management algorithm for acute onset of cen tral diabetes insipidus (CDI), and conducted a retrospective evaluatio n of its efficacy, Fourteen patients admitted to our pediatric intensi ve care unit (PICU) over a three year period were diagnosed with acute CDI secondary to various brain injuries, All patients were treated as per the algorithm guidelines, The initial dose of aqueous vasopressin ranged from 0.25 to 1.0 mU/kg/h, Low sodium content solution (0-0.5 n ormal saline) was used to replace urine output in excess of 3 ml/kg/h and for maintenance fluid therapy, The therapeutic goals included: uri ne output 2-3 ml/kg/h, urine specific gravity 1.010-1.020 and serum so dium 140-145 mEq/l, The pitressin dose was adjusted as deemed necessar y to achieve the aforementioned goals, Our results indicate that urine specific gravity is the most sensitive parameter to respond to treatm ent, It was the best determinant of the adequacy of pitressin dose as it had the best linear correlation with it (r=0.96; p=0.009), Urine ou tput was second best (r=O.93; p=0.02), whereas no linear correlation w as established between pitressin dose and serum sodium concentration, nor with serum osmolality. We conclude that the algorithm developed an d used by us for the management of CDI is generally efficacious, Chang es in urine specific gravity follow changes in pitressin dose very clo sely and thus should be used as the primary parameter for determinatio n of intravenous pitressin dose adjustment.