Nephrogenic Diabetes Insipidus in Childhood: Assessment of Volume Status and Appropriate Fluid Replenishment

Pediatric Emergency Care
Stefano GuarinoPierluigi Marzuillo

Abstract

Patients affected by nephrogenic diabetes insipidus (NDI) can present with hypernatremic dehydration, and first-line rehydration schemes are completely different from those largely applied in usual conditions determining a mild to severe hypovolemic dehydration/shock. In reporting the case of a patient affected by NDI and presenting with severe dehydration triggered by acute pharyngotonsillitis and vomiting, we want to underline the difficulties in managing this condition. Restoring the free-water plasma amount in patients affected by NDI may not be easy, but some key points can help in the first line management of these patients: (1) hypernatremic dehydration should always be suspected; (2) even in presence of severe dehydration, skin turgor may be normal and therefore the skinfold recoll should not be considered in the dehydration assessment; (3) decreased thirst is an important red flag for dehydration; (4) if an incontinent patient with NDI appears to be dehydrated, it is important to place the urethral catheter to accurately measure urine output and to be guided in parenteral fluid administration; (5) if the intravenous route is necessary, the more appropriate fluid replenishment is 5% dextrose in water with an infusion ra...Continue Reading

References

Sep 2, 1999·Pediatrics·M L Moritz, J C Ayus
Aug 3, 2002·Pediatrics in Review·Laurence Finberg
Jan 17, 2009·Pediatric Emergency Care·Samuel R Reid, Joseph D Losek
Jun 6, 2013·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Detlef Bockenhauer, Daniel G Bichet
Jan 1, 2015·The New England Journal of Medicine·Richard H Sterns
Jun 17, 2015·Nature Reviews. Nephrology·Detlef Bockenhauer, Daniel G Bichet
Sep 5, 2015·American Journal of Nephrology·Farahnak Assadi, Fatemeh Ghane Sharbaf
Jan 31, 2017·Current Opinion in Pediatrics·D Bockenhauer, Daniel G Bichet
Feb 18, 2017·The Journal of Emergency Medicine·Pierluigi MarzuilloGiovanni Montini

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