Diabetes Insipidis in Intensive Care

Diabetes Insipidis (DI) frequently occurs as a complication of severe head injury, usually in the terminal stages. It is caused by damage/destruction of the pituitary gland/hypothalamus. In the absence of anti diuretic hormone (ADH), the kidney is unable to concentrate the urine and a massive diuresis follows. The disorder is characterized by an increase in plasma osmolality, in the presence of a low urinary osmolality.
As a rule of thumb – the serum osmolality must be above 300 mOsm/kg (with a serum sodium > 145 mEq/l) and the urinary osmolality < 300 mOsm/kg. Following diagnosis, it is essential to keep up with fluid losses, and this may require the use of vasopressin analogues (DDAVP 1 to 4 micrograms 12 hourly).

Copyright Patrick Neligan 2001-2002

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