par Brimioulle, Serge 
Référence Textbook of Critical Care, Elsevier, page (1111.e1-1114.e1)
Publication Publié, 2023-01
Référence Textbook of Critical Care, Elsevier, page (1111.e1-1114.e1)
Publication Publié, 2023-01
Partie d'ouvrage collectif
| Résumé : | Diabetes insipidus is characterized by polyuria, urine hypotonicity, and hypernatremia. Central diabetes insipidus results from a lack of antidiuretic hormone (ADH); nephrogenic diabetes insipidus results from renal insensitivity to ADH. In the intensive care unit (ICU), diabetes insipidus is most often caused by pituitary surgery, trauma, and brain death. Clinical signs are related to polyuria-induced dehydration and hypernatremia. ICU patients generally are unable to compensate for excessive urine losses by drinking. The differential diagnosis includes administration of diuretics, mannitol, and iodinated agents. In the initial treatment, the polyuria should be controlled with desmopressin, 10-20 mg μg intranasally or 2-4 mg μg intravenously, and the water deficit should be corrected with enteral water or intravenous 5% dextrose in water. To prevent worsening or relapse, the diuresis should be monitored hourly, ongoing urinary losses should be compensated, and desmopressin should be repeated as needed. |
