Diabetes Insipidus: Diagnosis and Treatment

How Do Doctors Treat Diabetes Insipidus (DI)?

Central or neurogenic DI and nephrogenic DI are treated differently.

Central (neurogenic) DI

We treat central or neurogenic DI by giving medication to provide the vasopressin effects that the body needs. This medication comes in 2 forms, which are:

• Vasopressin given as an injection. The effects of the vasopressin injection last for only a few minutes.
• As a medication called desmopressin. The effects of desmopressin last for 8-24 hours. Desmopressin can be given as a nasal sniff (a mist you sniff through your nose), a pill or an injection. It is usually given about 2 times a day. When your child takes desmopressin, it’s a good idea to make sure your child has urinated before taking the next dose. This will help make sure your child doesn’t become overloaded with fluid.
• We can also help treat DI by making sure children drink fluids only when they are thirsty and not just because they want or like a drink. This will help prevent them from becoming overloaded with fluid.
• Sometimes, it can be difficult to treat babies with central DI with desmopressin because they need to take in so much fluid to get the nutrition they need. They often do better when they are treated with hydrochlorothiazide, given as a pill or liquid and a diluted (watered down), low-protein formula until they are mostly taking solid foods. Hydrochlorothiazide works on the kidneys to help hold onto the water your baby’s body needs.

Nephrogenic DI

We treat nephrogenic DI in a few ways, such as:

• Following a low-protein diet
• Drinking fluids that are mostly plain water
• Giving drugs like hydrochlorothiazide
• Because nephrogenic DI is sometimes caused by kidney damage, treating the reason for the kidney damage can help the kidneys heal so they can respond to vasopressin normally. This might include:
  • Stopping medications that cause nephrogenic DI
  • Treating a kidney infection
  • Correcting imbalances in calcium and potassium

What is the Outlook for Children with DI?

Children with central or neurogenic DI do well when they are treated appropriately with medication. If your child has idiopathic DI, he/she will need frequent examinations, including MRIs of the pituitary gland, to see if there is a cause that we haven’t been able to find.

The outcomes of children with a known reason for central or neurogenic DI depend on the cause of the DI. For example, if your child had a head injury, he/she should lead a normal life if the brain injury heals. However, your child will still need to take medication for DI. Sometimes, central or neurogenic DI from a head injury or after surgery slowly gets better on its own. This is because the nerve fibers from the hypothalamus that were cut off slowly grow back and store vasopressin again.

Children with nephrogenic DI often do quite well if their DI was caused by a medication that can be stopped or from a chemical abnormality that can be controlled. Children who are born with nephrogenic DI should be treated carefully to protect their kidneys as much as possible. They should also stay hydrated, even when they are sick, so their brain development is protected. This is especially true for young children.

Children with central or neurogenic DI do well when they are treated appropriately with medication. If your child has idiopathic DI, he/she will need frequent examinations, including MRIs of the pituitary gland, to see if there is a cause that we haven’t been able to find.

The outcomes of children with a known reason for central or neurogenic DI depend on the cause of the DI. For example, if your child had a head injury, he/she should lead a normal life if the brain injury heals. However, your child will still need to take medication for DI. Sometimes, central or neurogenic DI from a head injury or after surgery slowly gets better on its own. This is because the nerve fibers from the hypothalamus that were cut off slowly grow back and store vasopressin again.

Children with nephrogenic DI often do quite well if their DI was caused by a medication that can be stopped or from a chemical abnormality that can be controlled. Children who are born with nephrogenic DI should be treated carefully to protect their kidneys as much as possible. They should also stay hydrated, even when they are sick, so their brain development is protected. This is especially true for young children

When Should I Call the Doctor?

Call the doctor if your child...

• Is vomiting or has diarrhea from an illness. He/she should be seen immediately by a doctor so they don’t develop severe dehydration.
• Is hospitalized, has surgery or needs intravenous (IV) fluids. Ask your other health care providers to contact your child’s endocrinologist or nephrologist. The doctor who treats your child’s DI can help decide which IV fluids and medications your child should have.

Rev. 9/2015. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.