Transient Diabetes Insipidus in a Preterm Neonate: An Uncommon Cause of Neonatal Shock
Background: Diabetes insipidus (DI) is a disorder of water homeostasis due to insufficient production or inappropriate action of vasopressin. Central DI (CDI) develops due to intracranial causes such as hypoxic–ischemic encephalopathy, meningitis, and intraventricular hemorrhage. Manifestations such...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Indian Pediatrics Case Reports |
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| Online Access: | http://www.ipcares.org/article.asp?issn=2772-5170;year=2022;volume=2;issue=3;spage=171;epage=173;aulast=Kartikeswar |
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| author | Gouda Ankula Prasad Kartikeswar Dhyey J Pandya Ashwini T Mehetre Sandeep Kadam |
| author_facet | Gouda Ankula Prasad Kartikeswar Dhyey J Pandya Ashwini T Mehetre Sandeep Kadam |
| author_sort | Gouda Ankula Prasad Kartikeswar |
| collection | DOAJ |
| description | Background: Diabetes insipidus (DI) is a disorder of water homeostasis due to insufficient production or inappropriate action of vasopressin. Central DI (CDI) develops due to intracranial causes such as hypoxic–ischemic encephalopathy, meningitis, and intraventricular hemorrhage. Manifestations such as polyuria, polydipsia, and irritability may not be obvious in preterm infants, resulting in delayed recognition and difficulty in establishing diagnosis. Clinical Description: A 1.4 kg preterm girl delivered by cesarean section for a significant nonstress test (but normal Apgar scores) was admitted for very low birth weight and preterm care. Initial clinical examination was normal, and the baby remained euglycemic. The neonate developed shock and fever on the 3rd day of life without any apparent cause. Management: DI was suspected on identification of hypernatremia (150 mEq/L) and polyuria (9 mL/kg/h). The urine osmolality was low (62.54 mOsmol/kg), despite high serum osmolality (312 mOsmol/kg) confirming the diagnosis. An increase in urine osmolality by >50% following oral desmopressin (5 μg/kg/day) suggested CDI. This was continued until the baby became asymptomatic and urine/serum osmolality normalized. A trial of discontinuation of desmopressin did not lead to recurrence of symptoms. Magnetic resonance imaging brain showed features of subacute hypoxic insult and absent posterior pituitary bright spot. After 7 months of follow-up, she is asymptomatic without any treatment, and her growth and development are age appropriate. Conclusion: A high index of suspicion of CDI should be kept in neonates presenting with unexplained shock, fever, hypernatremia, and polyuria. |
| first_indexed | 2024-04-24T19:26:42Z |
| format | Article |
| id | doaj.art-8fb5870a7cf54c6f857f50dac9775098 |
| institution | Directory Open Access Journal |
| issn | 2772-5170 2772-5189 |
| language | English |
| last_indexed | 2024-04-24T19:26:42Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Pediatrics Case Reports |
| spelling | doaj.art-8fb5870a7cf54c6f857f50dac97750982024-03-25T15:38:51ZengWolters Kluwer Medknow PublicationsIndian Pediatrics Case Reports2772-51702772-51892022-01-012317117310.4103/ipcares.ipcares_83_22Transient Diabetes Insipidus in a Preterm Neonate: An Uncommon Cause of Neonatal ShockGouda Ankula Prasad KartikeswarDhyey J PandyaAshwini T MehetreSandeep KadamBackground: Diabetes insipidus (DI) is a disorder of water homeostasis due to insufficient production or inappropriate action of vasopressin. Central DI (CDI) develops due to intracranial causes such as hypoxic–ischemic encephalopathy, meningitis, and intraventricular hemorrhage. Manifestations such as polyuria, polydipsia, and irritability may not be obvious in preterm infants, resulting in delayed recognition and difficulty in establishing diagnosis. Clinical Description: A 1.4 kg preterm girl delivered by cesarean section for a significant nonstress test (but normal Apgar scores) was admitted for very low birth weight and preterm care. Initial clinical examination was normal, and the baby remained euglycemic. The neonate developed shock and fever on the 3rd day of life without any apparent cause. Management: DI was suspected on identification of hypernatremia (150 mEq/L) and polyuria (9 mL/kg/h). The urine osmolality was low (62.54 mOsmol/kg), despite high serum osmolality (312 mOsmol/kg) confirming the diagnosis. An increase in urine osmolality by >50% following oral desmopressin (5 μg/kg/day) suggested CDI. This was continued until the baby became asymptomatic and urine/serum osmolality normalized. A trial of discontinuation of desmopressin did not lead to recurrence of symptoms. Magnetic resonance imaging brain showed features of subacute hypoxic insult and absent posterior pituitary bright spot. After 7 months of follow-up, she is asymptomatic without any treatment, and her growth and development are age appropriate. Conclusion: A high index of suspicion of CDI should be kept in neonates presenting with unexplained shock, fever, hypernatremia, and polyuria.http://www.ipcares.org/article.asp?issn=2772-5170;year=2022;volume=2;issue=3;spage=171;epage=173;aulast=Kartikeswardesmopressinhypernatremianeonatal diabetes insipidusneonatal shockpolyuria |
| spellingShingle | Gouda Ankula Prasad Kartikeswar Dhyey J Pandya Ashwini T Mehetre Sandeep Kadam Transient Diabetes Insipidus in a Preterm Neonate: An Uncommon Cause of Neonatal Shock Indian Pediatrics Case Reports desmopressin hypernatremia neonatal diabetes insipidus neonatal shock polyuria |
| title | Transient Diabetes Insipidus in a Preterm Neonate: An Uncommon Cause of Neonatal Shock |
| title_full | Transient Diabetes Insipidus in a Preterm Neonate: An Uncommon Cause of Neonatal Shock |
| title_fullStr | Transient Diabetes Insipidus in a Preterm Neonate: An Uncommon Cause of Neonatal Shock |
| title_full_unstemmed | Transient Diabetes Insipidus in a Preterm Neonate: An Uncommon Cause of Neonatal Shock |
| title_short | Transient Diabetes Insipidus in a Preterm Neonate: An Uncommon Cause of Neonatal Shock |
| title_sort | transient diabetes insipidus in a preterm neonate an uncommon cause of neonatal shock |
| topic | desmopressin hypernatremia neonatal diabetes insipidus neonatal shock polyuria |
| url | http://www.ipcares.org/article.asp?issn=2772-5170;year=2022;volume=2;issue=3;spage=171;epage=173;aulast=Kartikeswar |
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