Laboratory findings revealed a normal complete blood count, normal serum electrolytes, and normal renal, liver, and thyroid functions, but his plasma BNP level A troponin test was negative. He then discontinued azosemide on his own judgment.
His subsequent clinical course during desmopressin replacement was uneventful, without recurrence of HF Figs 1 , 2 C and 3 C. He did not exhibit hyponatremia or low PRA, but 7 months after the same desmopressin replacement, he exhibited symptomatic HF without verifiable causes except for excess salt intake, which resolved rapidly during several days of oral diuretics under continued desmopressin therapy. Following strict restriction of dietary salt and water, he had no recurrent symptomatic HF. The primary stimulus for AVP secretion under normal physiological conditions is an increase in Posm.
Conversely, an excessive administration of desmopressin can cause decreased Posm and hyponatremia in association with excessive water retention 3 , 4. In the present case, the patient never exhibited hyponatremia during the course of the minimum effective dose of desmopressin therapy for his CDI Fig.
What's to know about diabetes insipidus?
Additionally, PRA, which would decrease if the extracellular fluid volume increases 12 , was not low during that period. These findings suggest that excessive retention of water in the body was not clinically detected by measuring electrolytes, Posm, or PRA during desmopressin treatment in our patient. Few studies have investigated the effects of AVP deficiency or desmopressin replacement on cardiac performance in patients with abnormal cardiac function.
However, a study on patients with CDI without a cardiac disorder suggested that AVP deficiency induces reversible changes in cardiac function, such as increased HR and LV contractility in association with relative hypovolemia That study also suggested that AVP deficiency induces subclinically altered LV diastolic function that persists even after treatment with adequate doses of desmopressin.
In the present case, the echocardiogram systolic parameters including LVEF and fractional shortening were similar before the development of CDI and after desmopressin therapy Fig. However, other cardiac parameters such as the inferior vena cava diameter 14 and plasma levels of BNP 15 were large or high especially after commencement of desmopressin therapy and before strict dietary sodium restriction, compared with those during the other period.
Case Report ARTICLE
Taken together, these findings suggest that our patient probably became more susceptible to HF after he developed CDI and underwent the desmopressin therapy than had been the case previously. Myocardial scintigraphy with thallium showed decreased uptake in the posterior wall of the left ventricle, and a left ventriculography showed an akinetic region at that area in the absence of coronary artery lesion. Based on these results, although his mitral valve regurgitation or AF might have contributed in part to his LV dysfunction 2 , the major etiology of the patient's LV dysfunction remains unclear.
A careful check of cardiac function along with the course of desmopressin therapy for CDI was required in this case. Central diabetes insipidus can be caused by the destruction or degeneration of neurons that originate in the supraoptic and paraventricular nuclei of the hypothalamus. Known causes of these lesions include tumors, local inflammatory, autoimmune or vascular diseases, trauma, and surgery, but many CDI cases are of unknown cause 1.
The present patient developed acute thirst and polyuria due to AVP deficiency without verifiable causal factors Fig. In conclusion, we reported a patient with CDI and cardiac dysfunction who developed HF during treatment with a minimum effective dose of desmopressin replacement. This is a single case study and thus does not provide a specific therapeutic proposal, including dosage calculation for desmopressin, on the management of CDI associated with cardiac dysfunction. However, this case suggests that patients with cardiac dysfunction may become more susceptible to HF after they develop CDI and undergo desmopressin therapy than previously.
Therefore, to prevent HF in patients with CDI accompanied by abnormal cardiac function, it is essential to control sodium and water intake using the effective minimum dose of desmopressin. We thank the medical laboratory technicians of Nagaoka Red Cross Hospital for their helpful technical support. Volume 4 , Issue The full text of this article hosted at iucr.
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Case Report Open Access. Nobumasa Ohara Corresponding Author E-mail address: oharan med. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Introduction Arginine vasopressin AVP is an antidiuretic hormone produced in the hypothalamus and stored in the posterior pituitary gland 1. Figure 1 Open in figure viewer PowerPoint.
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Clinical course. Blood samples were taken in the morning with the patient in the supine position.
The reference range for each parameter is shown in parentheses. The patient refrained from eating and drinking 2 h before and for the duration of the test.
Figure 2 Open in figure viewer PowerPoint. Electrocardiogram records. Figure 3 Open in figure viewer PowerPoint. Figure 4 Open in figure viewer PowerPoint.
Nephrogenic Diabetes Insipidus - Cancer Therapy Advisor
Magnetic resonance imaging of the pituitary gland November Acknowledgment We thank the medical laboratory technicians of Nagaoka Red Cross Hospital for their helpful technical support. Consent Written informed consent was obtained from the patient for publication of this case report. These include urinalysis, fluid deprivation, and even MRI scans.
If a GP thinks a patient may have DM, they will carry out a urine glucose test, which should result negatively if the patient has DI. If you have a mild form of DI, usually only passing around litres of urine a day, you may not be given any treatment and told that the disorder is manageable by drinking plenty of water. Desmopressin is a manufactured version of ADH given as a medication for diabetes insipidus. It acts in place of the natural hormone your body can't produce.
In more extreme cases of DI, desmopressin may be prescribed in either a tablet or a nasal spray form. The nasal spray is more effective, and gets into the bloodstream more efficiently and quicker, but can be blocked by colds or flu. The main concern with desmopressin is overdosing, as this can cause your body to retain too much water. Stick to the dosage your doctor has prescribed and don't increase the dose if it is 'not working'.
Consult your doctor if the symptoms persist, even whilst on treatment. Thiazide diuretics are a type of medication that increases urination rate but can strangely help prevent urination in sufferers of diabetes insipidus. This is because thiazides increase the concentration of the waste product in the urine, which can have a consequential effect of reducing the amount of urine produced in DI sufferers. Nephrogenic DI is much harder to treat. This is because there is a problem with the kidneys themselves, not just the message that tells them what to do. If you are on a medication containing lithium, coming off that prescription may help.
Water deprivation test
However, you should not alter your medication without consulting your doctor, and they will tell you what to take or try to find and alternative treatment. Dietary changes may also help to alleviate your symptoms, but again, consult your GP before making any drastic change to your diet. Prediabetes Gestational Type 1. Pregnancy Parents Youth. Diabetes Management. Follow Diabetescouk. Weight loss Diet and exercise can help to reverse prediabetes. Prediabetes Cookbook Over 50 lower-carb breakfast, lunch and dinner ideas for the whole family. Prediabetes Forum Ask questions and find support from other people with prediabetes.
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