Normal hemodynamic and coagulation responses to 1-deamino-8-D-arginine vasopressin in a case of lithium-induced nephrogenic diabetes insipidus. Results of treatment by a prostaglandin synthesis inhibitor (indomethacin).
The effect of 1-deamino-8-D-arginine vasopressin (DDAVP) on mean arterial pressure, pulse rate (PR), plasma renin activity (PRA), plasma factor VIIIc and von Willebrand factor were studied in a case of persistent lithium-induced nephrogenic diabetes insipidus (LINDI). 20% decrease in MAP, 22% increase in PR, 100% in PRA, and release of coagulation factors (2- to 3-fold) were noticed after infusion of 0.3 micrograms/kg DDAVP. Urinary prostaglandin (PG) E2 were enhanced. The treatment of this LINDI by PG synthesis inhibitor (PSI) combined with a low osmotic diet (LOD) led to a 51% fall in urine volume, 57% in free water clearance and 75% in sodium clearance. Urinary osmolality rose by 42% but remained low, probably in part because of the LOD. Urinary PGE2 was about one fifth of the initial high value. The results argue for (1) an end-organ resistance to DDAVP confined to the kidneys in LINDI and (2) an effectiveness of indomethacin combined with an LOD.
Hober
C
C
Service d'Endocrinologie et Métabolismes, C.H.U. Lille, France.
Vantyghem
M C
MC
Racadot
A
A
Cappoen
J P
JP
Lefebvre
J
J
D000328:Adult; D001777:Blood Coagulation; D001794:Blood Pressure; D003894:Deamino Arginine Vasopressin; D003919:Diabetes Insipidus / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology; D015232:Dinoprostone / Q000652:urine; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008094:Lithium / Q000009:adverse effects*; D011674:Pulse; D012083:Renin / Q000097:blood; D014868:Water Deprivation; D014841:von Willebrand Factor / Q000378:metabolism
D014841:von Willebrand Factor; D005169:Factor VIII; D008094:Lithium; D012083:Renin; D003894:Deamino Arginine Vasopressin; D015232:Dinoprostone