Thiazide Diuretics in the Management of Young Children with Central Diabetes Insipidus
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Published on: August 30, 2010
1Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN; Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.
Insights
Thiazide diuretics are safe and effective for treating central diabetes insipidus (DI) in infants and toddlers. This treatment can continue until a lack of response is observed, with minimal hospitalizations.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Pharmacology
Background:
- Central diabetes insipidus (DI) is a rare condition characterized by inadequate antidiuretic hormone production or action.
- Infants and toddlers with DI require careful management to prevent dehydration and electrolyte imbalances.
Purpose of the Study:
- To evaluate the safety and efficacy of thiazide diuretics in treating central diabetes insipidus (DI) in young children.
- To assess the duration of treatment and reasons for cessation.
Main Methods:
- Retrospective chart review of 13 infants and toddlers treated with thiazide diuretics for central DI between 1996 and 2014.
- Analysis of patient demographics, medication dosages (chlorothiazide or hydrochlorothiazide), treatment duration, and clinical outcomes.
Main Results:
- Thiazide therapy was initiated at a median age of 6 months and stopped at a median of 18 months.
- The primary reasons for cessation were lack of response and hypernatremia.
- No hospitalizations for hyponatremia occurred; one hospitalization for hypernatremia was reported.
- Persistent hypercalcemia was observed in 2 of 7 patients with periodic calcium monitoring.
Conclusions:
- Thiazide diuretics represent a safe and effective treatment option for central DI in infants and toddlers.
- Treatment can be safely continued after the introduction of solid foods and until therapeutic response wanes.
Objective:
To report our experience in treating infants and toddlers with central diabetes insipidus (DI) with thiazide diuretics.
Study Design:
A retrospective chart review of all infants and toddlers who were treated with thiazide diuretics for central DI at the Mayo Clinic between 1996 and 2014.
Results:
Our cohort consisted of 13 patients. The median age at the start of therapy was 6 months (IQR, 1-14 months). Eight patients were given chlorothiazide at a starting dose of 5-10 mg/kg/day, and 5 patients were treated with hydrochlorothiazide at a starting dose of 1-2 mg/kg/day. The median age at the cessation of thiazide therapy was 18 months (IQR, 11.5-39 months). The main reason for stopping was the lack of continued response, in addition to hypernatremia. There was no hospitalization secondary to hyponatremia and only 1 hospitalization secondary to hypernatremia while receiving thiazide therapy. Calcium was checked periodically in 7 of the 13 patients, and 2 of these 7 patients had persistent hypercalcemia.
Conclusion:
Thiazide diuretics appear to be safe and effective in treating infants with central DI. They can be continued after the introduction of solid food, and until a lack of response is observed.
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