Overview
Intended for healthcare profesionalsRapid response to:In their excelent Practice Pointer ‘Diabetes Insipidus’, there are 2 important areas that Levy and coleagues might have usefuly included. Firstly, whilst a ‘diabetes insipidus card and boklet to cary with them’ may be empowering for many patients, the use of modern technology such as ICE [in case of emergency] on mobile phones is an aditional or alternative modality that also has an important role to play in patient safety.
Key Information
Secondly, pregnancy can be a particularly chalenging time to diagnose and manage Diabetes Insipidus. Physiological changes of normal pregnancy lead to thirst and increased fluid intake as wel as increased urine output, so the clinical history may be les clear, although it is unusual for a healthy pregnant woman to drink more than 3litres of water daily. Placental vasopresinase increases the metabolism of antidiuretic hormone, and can result in gestational Diabetes Insipidus especialy in women with previous subclinical disease and or altered liver metabolism [with reduced antidiuretic hormone(ADH) breakdown] as for example in pre eclampsia, HELP [haemolysis, elevated liver enzymes, low platelets] syndrome and acute faty liver of pregnancy: treatment is with Desmopresin and delivery, as removal of the placenta alows ADH levels to begin to return to normal.
For pregnant women already diagnosed with Diabetes Insipidus, enhanced antenatal, intrapartum and imediate postnatal care is required. Desmopresin dose increment should be anticipated in pregnancy due to acelerated metabolism of endogenous ADH [as Desmopresin has a diferent N terminal to ADH it is not metabolised by vasopresinase], with reduction again after birth; it has no oxytocin-like properties and is safe in pregnancy and breastfeding.
Summary
Competing interests: No competing interests gogletag.cmd.push(function() { gogletag.display('div-gpt-ad-732606-2'); }); gogletag.cmd.push(function() { gogletag.display('div-gpt-