Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults
We do not recommend population screening for diabetes insipidus (DI) (B3). We recommend to perform diagnostic testing for central diabetes insipidus (CDI) in patients who underwent neurosurgery, after skull and brain trauma, subarchnoid hemorrhage (B3). We recommend excluding thirst impairment durin...
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| Format: | Article |
| Language: | English |
| Published: |
Endocrinology Research Centre
2018-07-01
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| Series: | Ожирение и метаболизм |
| Subjects: | |
| Online Access: | https://www.omet-endojournals.ru/jour/article/view/9670 |
| _version_ | 1827121738889035776 |
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| author | Ivan I. Dedov Galina A. Mel'nichenko Ekaterina A. Pigarova Larisa K. Dzeranova Liudmila Y. Rozhinskaya Elena G. Przhiyalkovskaya Zhanna E. Belaya Andrey Y. Grigoriev Alexander V. Vorontsov Alexander S. Lutsenko Ludmila I. Astafyeva |
| author_facet | Ivan I. Dedov Galina A. Mel'nichenko Ekaterina A. Pigarova Larisa K. Dzeranova Liudmila Y. Rozhinskaya Elena G. Przhiyalkovskaya Zhanna E. Belaya Andrey Y. Grigoriev Alexander V. Vorontsov Alexander S. Lutsenko Ludmila I. Astafyeva |
| author_sort | Ivan I. Dedov |
| collection | DOAJ |
| description | We do not recommend population screening for diabetes insipidus (DI) (B3). We recommend to perform diagnostic testing for central diabetes insipidus (CDI) in patients who underwent neurosurgery, after skull and brain trauma, subarchnoid hemorrhage (B3). We recommend excluding thirst impairment during all stages of diagnostic assessment (С3). We recommend excluding DI in cases of persistent hypotonic polyuria: excretion of more than 3 L. or more than 40 mL/kg of urine daily; urine osmolality less than 300 mOsm/kg or urinary specific gravity less than 1004 g/L in all urine samples or during Zimnitsky test (В3). After hypotonic polyuria is confirmed, we recommend excluding of the main causes of nephrogenic diabetes insipidus (NDI) (B3). We recommend simultaneous measurement of urine osmolality and blood osmolality/sodium level in order to confirm DI. Blood hyperosmolality (more than 300 mOsm/kg) and/or hypernatremia with low urine osmolality (less than 300 mOsm/kg) confirms DI (B2). If testing does not reveal these findings, we recommend performing a fluid deprivation test to exclude primary polydipsia (PP) (B2). Desmopressin test is recommended to distinguish CDI and NDI (B2). In cases of CDI we recommend to perform head MRI with contrast (B3). In cases of NDI we recommend assessing renal structure and function and possible electrolyte disturbances (C3). In cases of PP we recommend to refer a patient to psychiatrist (B3). We recommend treating CDI with synthetic vasopressin analogue – desmopressin (B1). We recommend an individual approach in choosing desmopressin dosage form (B2). As the initial dose is difficult to predict when starting desmopressin treatment, we recommend titrating the dosage using two approaches: “the average dose” and “as required” (C4). We recommend educating the patients to ensure knowledge of the features of various desmopressin dosage forms (C4). To decrease the risk of water intoxication, we recommend educating the patients to the water intake regimen adherence (С4). When CDI is accompanied by thirst impairment, we recommend titrating the dose in a clinical setting, with assessment of blood sodium, bodyweight and/or urine volume (C4). |
| first_indexed | 2024-03-08T09:13:43Z |
| format | Article |
| id | doaj.art-dfedfcfecfa84154932655799d58c6b5 |
| institution | Directory Open Access Journal |
| issn | 2071-8713 2306-5524 |
| language | English |
| last_indexed | 2025-03-20T13:57:55Z |
| publishDate | 2018-07-01 |
| publisher | Endocrinology Research Centre |
| record_format | Article |
| series | Ожирение и метаболизм |
| spelling | doaj.art-dfedfcfecfa84154932655799d58c6b52024-09-11T16:17:51ZengEndocrinology Research CentreОжирение и метаболизм2071-87132306-55242018-07-01152567110.14341/omet96708486Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adultsIvan I. Dedov0Galina A. Mel'nichenko1Ekaterina A. Pigarova2Larisa K. Dzeranova3Liudmila Y. Rozhinskaya4Elena G. Przhiyalkovskaya5Zhanna E. Belaya6Andrey Y. Grigoriev7Alexander V. Vorontsov8Alexander S. Lutsenko9Ludmila I. Astafyeva10<p>Endocrinology Research Centre</p><p>Endocrinology Research Centre</p><p>Endocrinology Research Centre</p><p>Endocrinology Research Centre</p><p>Endocrinology Research Centre</p><p>Endocrinology Research Centre</p><p>Endocrinology Research Centre</p><p>Endocrinology Research Centre</p><p>Endocrinology Research Centre</p><p>Endocrinology Research Centre</p><p>Burdenko Neurosurgical Institute</p>We do not recommend population screening for diabetes insipidus (DI) (B3). We recommend to perform diagnostic testing for central diabetes insipidus (CDI) in patients who underwent neurosurgery, after skull and brain trauma, subarchnoid hemorrhage (B3). We recommend excluding thirst impairment during all stages of diagnostic assessment (С3). We recommend excluding DI in cases of persistent hypotonic polyuria: excretion of more than 3 L. or more than 40 mL/kg of urine daily; urine osmolality less than 300 mOsm/kg or urinary specific gravity less than 1004 g/L in all urine samples or during Zimnitsky test (В3). After hypotonic polyuria is confirmed, we recommend excluding of the main causes of nephrogenic diabetes insipidus (NDI) (B3). We recommend simultaneous measurement of urine osmolality and blood osmolality/sodium level in order to confirm DI. Blood hyperosmolality (more than 300 mOsm/kg) and/or hypernatremia with low urine osmolality (less than 300 mOsm/kg) confirms DI (B2). If testing does not reveal these findings, we recommend performing a fluid deprivation test to exclude primary polydipsia (PP) (B2). Desmopressin test is recommended to distinguish CDI and NDI (B2). In cases of CDI we recommend to perform head MRI with contrast (B3). In cases of NDI we recommend assessing renal structure and function and possible electrolyte disturbances (C3). In cases of PP we recommend to refer a patient to psychiatrist (B3). We recommend treating CDI with synthetic vasopressin analogue – desmopressin (B1). We recommend an individual approach in choosing desmopressin dosage form (B2). As the initial dose is difficult to predict when starting desmopressin treatment, we recommend titrating the dosage using two approaches: “the average dose” and “as required” (C4). We recommend educating the patients to ensure knowledge of the features of various desmopressin dosage forms (C4). To decrease the risk of water intoxication, we recommend educating the patients to the water intake regimen adherence (С4). When CDI is accompanied by thirst impairment, we recommend titrating the dose in a clinical setting, with assessment of blood sodium, bodyweight and/or urine volume (C4).https://www.omet-endojournals.ru/jour/article/view/9670diabetes insipiduscentral diabetes insipiduspolyuriahypernatremiaarginine vasopressindesmopressin |
| spellingShingle | Ivan I. Dedov Galina A. Mel'nichenko Ekaterina A. Pigarova Larisa K. Dzeranova Liudmila Y. Rozhinskaya Elena G. Przhiyalkovskaya Zhanna E. Belaya Andrey Y. Grigoriev Alexander V. Vorontsov Alexander S. Lutsenko Ludmila I. Astafyeva Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults Ожирение и метаболизм diabetes insipidus central diabetes insipidus polyuria hypernatremia arginine vasopressin desmopressin |
| title | Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults |
| title_full | Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults |
| title_fullStr | Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults |
| title_full_unstemmed | Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults |
| title_short | Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults |
| title_sort | federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults |
| topic | diabetes insipidus central diabetes insipidus polyuria hypernatremia arginine vasopressin desmopressin |
| url | https://www.omet-endojournals.ru/jour/article/view/9670 |
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