Diabetes insipidus - what you need to know

Episode 34: Diabetes insipidus: Complications and Treatment Methods

Diabetes insipidus is a disease characterized by symptoms such as excessive thirst, frequent urination, and fatigue, but with normal blood glucose levels. While there are many different causes, there are generally three main types: central diabetes insipidus, nephrogenic diabetes insipidus, and diabetes insipidus in pregnant women. Therefore, complications and treatment are assessed based on these types and causes, as follows:

1. Complications of diabetes mellitus (DM) focus on the following three basic areas:

- All patients who developed complications were severely dehydrated.

- Excessive urination causes dilation of the collecting ducts, ureters, and bladder, leading to hydronephrosis and renal dysfunction. This is an important reason why diabetes incontinence should be treated even if the patient is still able to drink normally.

- Correcting hyperosmolarity too quickly risks causing cerebral edema.

2. Regarding the treatment of diabetes mellitus:

Treatment of central diabetes mellitus (DM); treatment of renal DM; and treatment of DM in pregnant women.

In this 34th installment, we introduce the principles of emergency treatment for central diabetes insipidus. Subsequent installments will continue to introduce the principles of long-term treatment for central diabetes insipidus and other forms caused by different factors.

Emergency treatment for severe dehydration includes:

- Give them plenty of water to drink if possible.

- Administer hypotonic fluids to restore circulating volume and reduce blood osmotic pressure.

- The infusion rate depends on the clinical symptoms and the duration of the disease. Infusing too quickly can lead to the risk of cerebral edema.

- Adjust osmotic pressure at a rate of 1-2 mosm/h, not exceeding 15 mosm/8 hours and 30 mosm/24 hours for the first 24 hours.

- The time required to replenish lost fluids is 48 hours. If the patient shows signs of cerebral edema, hypotonic fluids must be stopped immediately and replaced with hypertonic fluids (such as mannitol).

- Administer desmopressin acetate intravenously or intramuscularly, at a dose of 1-2 mcg/24h.

Doctor: Nguyen Van Hoan (Director of Nghe An Endocrinology Hospital)