Management of early postoperative diabetes insipidus with parenteral desmopressin.
Management of early postneurosurgical diabetes insipidus (DI) requires parenteral vasopressin before intranasal administration of desmopressin-1 desamino-8 D arginine vasopressin (dDAVP) can be initiated. We have evaluated in 15 neurosurgical patients the effect and the tolerance of a 3-day regimen of dDAVP administered im every 12 h. Patients were randomly ascribed to one of 3 treatment groups: 1 microgram (N = 6), 2 micrograms (N = 5) or 4 micrograms (N = 4) were administered twice daily. dDAVP was effective whatever the dose, and DI was corrected by the 6th h of treatment. Effects were maximal on diuresis and urinary osmolality from the 18th h onwards. The effects were sustained throughout the treatment period. Reversal to pretreatment status occurred 24 h after the last injection. Moreover, 72 h after the last injection, natremia and osmolality reached values significantly below pretherapeutic values. The tolerance was excellent: hyponatremia which occurred in 11 patients, either occasionally or throughout the treatment period, remained mild and never had clinical consequences. In conclusion, before initiation of intranasal dDAVP, a 3-day treatment by 1, 2 or 4 micrograms of dDAVP injected im twice daily in neurosurgical patients corrected DI. Mild overhydration owing to a positive fluid balance was a side-effect which is also encountered in other therapeutic methods necessitating meticulous control of water intake.
Chanson
P
P
Service de Neuro-Chirurgie, Hôpital Foch, Suresnes, France.
Jedynak
C P
CP
Czernichow
P
P
D000293:Adolescent; D000328:Adult; D002986:Clinical Trials as Topic; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D003919:Diabetes Insipidus / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011183:Postoperative Complications / Q000188:drug therapy*
D003894:Deamino Arginine Vasopressin