Aqueous vasopressin infusion during chemotherapy in patients with diabetes insipidus.
BACKGROUND
Patients who have suprasellar germinomas in childhood often present with central diabetes insipidus (CDI). The authors investigated the use of aqueous vasopressin (AVP) by continuous infusion to control the fluid and electrolyte balance in germinoma patients with CDI during aggressive fluid hydration as a part of a preirradiation chemotherapy protocol.


METHODS
Three patients with suprasellar germinomas and CDI were treated with four courses of preirradiation chemotherapy. Two patients were treated with a continuous AVP infusion at an initial rate of 0.08-0.10 mU/kg per hour during hydration. Fluid intake, urine output, body weight, urine specific gravity, and serum electrolyte concentrations were monitored closely, and the infusion rate was adjusted accordingly.


RESULTS
Very low dose AVP infusion controlled fluid balance while allowing appropriate diuresis during chemotherapy. Fluid intake and output were markedly less in the AVP-treated patients (3.8 L/m2 per day) than in the untreated patient (20 L/m2 per day).


CONCLUSIONS
The use of very low dose AVP infusion at an initial rate of 0.08-0.10 mU/kg per hour during hydration therapy allowed easily titratable control of fluid and electrolyte balance in the patients studied and avoided the complications associated with desmopressin acetate antidiuresis or withholding antidiuretic treatment altogether.
Bryant
W P
WP
Department of Pediatrics, Mayo Clinic, Rochester, MN 55905.
O'Marcaigh
A S
AS
Ledger
G A
GA
Zimmerman
D
D
D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D002648:Child; D003131:Combined Modality Therapy; D003919:Diabetes Insipidus / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D018237:Germinoma / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D014667:Vasopressins / Q000008:administration & dosage* / Q000627:therapeutic use
D014667:Vasopressins