Dear list members,
Concerning the fluid management in Diabetes incipidus.
Is there any reason to manage the child with DI and hypernatremic
dehydration any differently than other
children with hypernatremic dehydration?
The child in question is one year old and has DI and agenesis of the
corpus callosum. Her mother stopped giving
her the nasal puffs for three days. She was admitted with dehydration
10% and sodium of 170mmo/l. Urea
14mmol/l and creatinine 78 umol/l. She was polyuric.
After the the initial fluid rescusitation 10ml/kg normal sline over one
hour, slow rehydration with 0.45 %saline in 5
% D over 48 hours was given together with desmopressin. She made good
recovery and her sodium fell to 155
The question arose when a colleague produced a pediatric pocket book
stating that, for hypernatremic
dehydration due to DI, correction of the deficit should be done over
This is not supported by another emergency book (Manual of emergency
pediatrics by Robert Reece) which
states that "Uncompensated DI is treated with the slow and careful
rehydration required for any cause of
hypernatraemic hyperosmolar states". The latter view was what we always
accepted and follow.
Does anyone have any comments or any references that supports any of the
Thank you so much in advance.
Dr Dina Ramadan
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