title: Clinical review: Treatment of neurohypophyseal diabetes insipidus.
abstract: BACKGROUND
  In recent years, there have been several improvements in the treatment of neurohypophyseal diabetes insipidus (DI). They include new formulations of the vasopressin analog, desmopressin; a better understanding of the effect of fluid intake on dosing; and more information about treatments of infants, children, and pregnant women who present special challenges. This review aims to summarize past and current information relative to the safety and efficacy of treatments for the types of DI caused by a primary deficiency of vasopressin.
  
  
  METHODS
  The review is based on publications identified primarily by a PubMed search of the international literature without limitations of date.
  
  
  RESULTS
  In acute settings where fluid intake is determined by factors other than thirst, desmopressin should be given iv in doses that have a short duration of action and can be adjusted quickly in accordance with changes in hydration as indicated by plasma sodium. In ambulatory patients, the oral formulations (tablet or melt) are preferred for their convenience. If fluid intake is regulated normally by the thirst mechanism, the tablets or melt can be taken safely 1 to 3 times a day in doses sufficient to completely eliminate the polyuria. However, if fluid intake consistently exceeds replacement needs as evidenced by the development of hyponatremia, the dose should be reduced to allow higher than normal rates of urine output or intermittent breakthrough diuresis. This regimen is often indicated in infants or children because their rate of fluid intake tends to be greater than in adults. In all cases, the appropriate dose should be determined by titration, owing to considerable interindividual differences in bioavailability and antidiuretic effect.
  
  
  CONCLUSIONS
  Desmopressin can provide effective and safe therapy for all patients with neurohypophyseal or gestational DI if given in doses and by a route that takes into account the determinants of fluid intake.
authors.affiliation: University of Ghent, Faculty of Medicine and Health Sciences, 9000 Ghent, Belgium. KristanVinter.Juul@Ugent.be.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Oiso
authors.forename: Gary L
authors.initials: GL
authors.lastname: Robertson
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Nørgaard
authors.forename: Kristian Vinter
authors.initials: KV
authors.lastname: Juul
mesh_terms: D050034:Antidiuretic Agents / Q000627:therapeutic use*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D020790:Diabetes Insipidus, Neurogenic / Q000188:drug therapy*; D006801:Humans; D011141:Polyuria / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin