CENTRAL DIABETES INSIPIDUS AND CHEMOTHERAPY: USE OF A CONTINUOUS ARGININE VASOPRESSIN INFUSION FOR FLUID AND SODIUM...

Area of Science:

• Endocrinology
• Oncology
• Nephrology

Background:

• Central diabetes insipidus (CDI) can arise from tumors affecting the hypothalamic-pituitary axis.
• Standard CDI treatment involves fluid intake and desmopressin to manage urine output and maintain eunatremia.
• High-volume intravenous fluids during chemotherapy can cause dangerous sodium derangements in CDI patients.

Purpose of the Study:

• To develop and assess a protocol for managing central diabetes insipidus in patients undergoing chemotherapy.
• To maintain eunatremia (normal plasma sodium levels) during periods of high fluid intake.

Main Methods:

• Developed a protocol for a low-dose, continuous intravenous arginine vasopressin infusion.
• The infusion rate was rapidly titratable to maintain eunatremia.
• Applied the protocol during chemotherapy requiring obligate intravenous fluid administration.

Main Results:

• Successfully maintained eunatremia in two patients with central nervous system lymphoma.
• Patients received chemotherapy with 5% dextrose in 0.45% sodium chloride.
• The protocol prevented significant plasma sodium fluctuations.

Conclusions:

• Conventional desmopressin therapy can lead to severe sodium fluctuations in CDI patients requiring high-volume fluids.
• A continuous, titratable low-dose vasopressin infusion is effective in maintaining eunatremia in this clinical scenario.
• This protocol offers a method to prevent dangerous sodium shifts in CDI patients undergoing chemotherapy, though not yet assessed in renal impairment.