Hyponatremia and polyuria in children with central diabetes insipidus: Challenges in diagnosis and management

Five patients with well-controlled, long-standing central diabetes insipidu s had acute development of dehydration, hyponatremia, and inappropriate nat riuresis in the setting of polyuria resistant to exogenous antidiuretic hor mone. Hyponatremia and dehydration worsened with fluid restriction or use o f exogenous antidiuretic hormone. We discuss the challenges in diagnosis an d management of probable salt wasting in children with central diabetes ins ipidus.