Management of acute diabetes insipidus

For acute diabetes insipidus (eg after pituitary or hypothalamic surgery, after head injury), use parenteral desmopressin or argipressin (vasopressin) once the diagnosis has been confirmed. If urine output is high (eg above 250 mL/hour for more than 2 consecutive hours), measure serum sodium concentration and urine and plasma osmolality before starting treatment. Diabetes insipidus following an acute cause is commonly transient, often only requiring a single dose of desmopressin or argipressin (vasopressin) therapy. The dose can be repeated if polyuria recurs, and depending on electrolytes and osmolality.

To treat acute diabetes insipidus in an adult, use:

For a child, seek specialist advice.

Increasing the desmopressin dose increases the duration of its effect on water excretion, rather than the intensity of effect.

Argipressin (vasopressin) has a shorter duration of action than desmopressin, so may be preferred in acute diabetes insipidus to reduce the risk of iatrogenic hyponatraemia. Intravenous administration of argipressin (vasopressin) is not recommended, because it can cause pressor effects.

Using intravenous fluids during desmopressin or argipressin (vasopressin) therapy can lead to hyponatraemia resulting from impaired water excretion. Hyponatraemia can be avoided by ensuring that fluid intake does not exceed urine output in each 6- or 8-hour period.