title: Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study.
abstract: OBJECTIVE
  Patients with cranial diabetes insipidus (CDI) are at risk of developing both hypernatraemia and hyponatraemia, due to the condition itself or secondary to treatment with vasopressin-analogues or during administration of i.v. fluids. We aimed to assess the frequency and impact of dysnatraemias in the inpatient (INPT) and outpatient (OPT) setting in desmopressin-treated CDI, comparing those with normal thirst with those with abnormal thirst.
  
  
  METHODS
  The study included 192 patients with cranial diabetes, who were identified from the Beaumont Pituitary Database, a tertiary referral centre. Retrospective case note audit was performed and the clinical and biochemical information of 147 patients with CDI were available for analysis.
  
  
  RESULTS
  A total of 4142 plasma sodium measurements for 137 patients with normal thirst, and 385 plasma sodium measurements for ten patients with abnormal thirst were analysed. In those with normal thirst, the most common OPT abnormality was mild hyponatraemia (pNa(+) 131-134  mmol/l) in 27%, while 14.6% had more significant hyponatraemia (pNa(+) ≤130  mmol/l). Of those patients with normal thirst, 5.8% were admitted due to complications directly related to hyponatraemia. Compared with patients with normal thirst, those with abnormal thirst were more likely to develop significant OPT hypernatraemia (20% vs 1.4%, P=0.02) and significant INPT hyponatraemia (50% vs 11.1%, P 0.02).
  
  
  CONCLUSIONS
  OPT management of CDI is complicated by a significant incidence of hyponatraemia. In contrast, OPT hypernatraemia is almost exclusively a complication seen in adipsic CDI, who also had more frequent INPT hyponatraemia. CDI associated with thirst disorder requires increased physician attention and patient awareness of potential complications.
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: L A
authors.initials: LA
authors.lastname: Behan
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Sherlock
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Moyles
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: O
authors.initials: O
authors.lastname: Renshaw
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: C J T
authors.initials: CJ
authors.lastname: Thompson
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Orr
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Holte
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: M R
authors.initials: MR
authors.lastname: Salehmohamed
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Glynn
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
authors.forename: W
authors.initials: W
authors.lastname: Tormey
authors.affiliation: Academic Department of EndocrinologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, IrelandDepartment of EndocrinologyTrinity College, Adelaide and Meath Hospitals, Dublin, Incorporating the National Children's Hospital, Dublin, IrelandAcademic Department of Chemical PathologyRCSI Medical School, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland christhompson@beaumont.ie.
authors.forename: C J
authors.initials: CJ
authors.lastname: Thompson
mesh_terms: D000328:Adult; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D003919:Diabetes Insipidus / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000188:drug therapy; D007010:Hyponatremia / Q000097:blood / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood*; D055815:Young Adult
chemical_list: D012964:Sodium; D003894:Deamino Arginine Vasopressin