title: Central diabetes insipidus: alert for dehydration in very low birth weight infants during the neonatal period. A case report.
abstract: BACKGROUND
  Central diabetes insipidus (CDI) is a rare cause of hypernatremia during the neonatal period. The diagnosis is particularly difficult in very low birth weight (VLBW) newborns.
  
  
  METHODS
  We report on a preterm newborn who presented CDI soon after birth. On the third day of life, signs of dehydration were present despite normal fluid supply. The diuresis rate was 4.4 ml/kg/h. Although the fluid supply was then increased, the dehydration continued, with hypernatremia, normal glycemia, diuresis of 7.4 ml/kg/h and urine density of 1005 mOsmol/l. Thus, a diagnostic hypothesis of diabetes insipidus was raised. A test with a nasal vasopressin analogue (dDAVP) was performed and CDI was confirmed. Reduction of the fluid supply became possible through appropriate treatment.
  
  
  CONCLUSIONS
  The diagnosis of CDI is rarely made during the neonatal period, especially in VLBW newborns, because of the difficulty in detecting elevated diuresis. Persistent hypernatremia, usually accompanied by hyperthermia despite abundant fluid supply, weight loss and low urine osmolality are important signs of alert.
authors.affiliation: Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
authors.forename: Maria Lúcia Silveira
authors.initials: ML
authors.lastname: Ferlin
authors.affiliation: Department of Pediatrics, University Hospital, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
authors.forename: Débora Simone
authors.initials: DS
authors.lastname: Sales
authors.affiliation: Department of Pediatrics, University Hospital, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
authors.forename: Fábia Pereira Martins
authors.initials: FP
authors.lastname: Celini
authors.affiliation: Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Martinelli Junior
mesh_terms: D000281:Administration, Intranasal; D003894:Deamino Arginine Vasopressin; D003681:Dehydration / Q000188:drug therapy / Q000209:etiology*; D020790:Diabetes Insipidus, Neurogenic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004231:Diuresis; D042241:Early Diagnosis; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D006955:Hypernatremia / Q000097:blood; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D009994:Osmolar Concentration; D047928:Premature Birth; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D003894:Deamino Arginine Vasopressin