Case Report | Case Rep J. 2018;2(1):010 | Open Access
A Case of Neonatal Central Diabetes Insipidus in a Premature Infant - Challenges in Diagnosis and Management
Andrew Sng, Loke KY and Lim YPDF
Background: Neonatal central diabetes insipidus (CDI) has been associated with meningitis, central nervous system malformations, intraventricular hemorrhage and hypoxic ischemic encephalopathy.
Case Report: A 25 week premature male neonate with a birth weight of 804 grams had a stormy perinatal clinical course complicated by grade III bilateral intraventricular hemorrhage. On 69th day of life, he developed polyuria with a serum sodium of 157 mmol/L, serum osmolality of 352 mmol/kg and a urine osmolality of 181 mmol/kg, which was diagnostic of diabetes insipidus. Intravenous (IV) vasopressin was commenced at 0.1 mU/kg/h and titrated upwards to effect. He showed a gradual response over the next 72 h with a decrease in serum sodium to 133 mmol/L and serum osmolality to 269 mmol/kg and an increase in urine osmolality to 291 mmol/kg.
Discussion: To our knowledge, this is the first report of IV vasopressin in the diagnosis of CDI. Other studies have used intranasal desmopressin which has been associated with large swings in serum sodium. The advantage with the initial use of an IV vasopressin infusion lies in the titration of the dose in a controlled and safe manner to establish response.
Keywords: Neonatal diabetes; Diabetes insipidus
Citation: Sng A. A Case of Neonatal Central Diabetes Insipidus in a Premature Infant - Challenges in Diagnosis and Management. Case Rep J. 2018;2(1):010