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Central diabetes insipidus in children with acute brain insult

Yun-Hsuan Yang1, Jainn-Jim Lin, Shao-Hsuan Hsia

  • 1Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Pediatric Neurology
|November 26, 2011
PubMed

Insights

Central diabetes insipidus in children following brain injury is rare but associated with high mortality. Early diagnosis within 2 days and high serum sodium levels are key indicators of poor outcomes.

Area of Science:

  • Pediatric critical care medicine
  • Pediatric endocrinology
  • Pediatric neurology

Background:

  • Central diabetes insipidus (CDI) is a rare complication of severe central nervous system (CNS) injuries.
  • The clinical presentation and outcomes of acquired CDI in children after acute brain insult are not well-documented.

Purpose of the Study:

  • To describe the clinical characteristics, management, and outcomes of pediatric patients with acquired CDI following acute CNS injury.
  • To identify predictors of mortality in this patient population.

Main Methods:

  • Retrospective review of 54 pediatric patients (3 months–18 years) admitted to a tertiary pediatric intensive care unit between January 2000 and February 2008.
  • Analysis of etiologies, timing of CDI diagnosis, serum sodium levels, co-occurring syndromes, and mortality.

Main Results:

  • Common etiologies included CNS infection (35.2%), hypoxic-ischemic events (31.5%), head injury (18.5%), and vascular lesions (14.8%).
  • CDI was diagnosed within 2 days of injury in 72.2% of patients; 74.0% developed maximum serum sodium >160 mEq/L.
  • Overall 2-month mortality was 77.8%. Early CDI diagnosis and hypernatremia were significant predictors of outcomes.

Conclusions:

  • Acquired central diabetes insipidus in children after acute CNS injury is associated with a high mortality rate.
  • Early detection of CDI within 48 hours and a maximum serum sodium concentration exceeding 160 mEq/L are critical indicators for predicting patient outcomes.

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