Diabetes insipidus in severely brain damaged children

Nineteen children aged four months to 15 years with diabetes insipidus (DI) secondary to severe brain insults were studied. The main primary brain insult was severe head injury in 12, anoxic ischemic brain damage in four, encephalitis in two, Reye's syndrome in one. Sixteen children died, and three survived. The time from insult to onset of polyuria varied from several hours to one month, and was significantly shorter in head trauma patients, 1.8 +/- 0.9 vs. 9.3 +/- 1.9 days for patients with anoxic ischemic brain damage (p less than 0.03). Twelve of the 19 patients met the criteria for brain death at onset of DI. Treatment by appropriate fluids and vasopressin resulted in resolution of polyuria and increase in urine osmolality. Ten patients developed DI while being treated with dopamine for hemodynamic support. In two of these patients, the cessation of dopamine was time-related to the resolution of DI. Our results indicate that as many as 15% of children with DI (with 95% confidence) following severe brain injury may survive. Hence, despite the overall poor prognosis, its occurrence does not necessarily indicate brain death.