Nephrogenic Diabetes Insipidus in Childhood: Assessment of Volume Status and Appropriate Fluid Replenishment
Autor: | Lorenzo Cerrone, Emanuele Miraglia del Giudice, Rosaria Marotta, Anna Pecoraro, Stefano Guarino, Mario Diplomatico, Daniela Furlan, Angela La Manna, Cesare Polito, Pierluigi Marzuillo |
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Přispěvatelé: | Guarino, Stefano, Diplomatico, Mario, Marotta, Rosaria, Pecoraro, Anna, Furlan, Daniela, Cerrone, Lorenzo, Miraglia Del Giudice, Emanuele, Polito, Cesare, La Manna, Angela, Marzuillo, Pierluigi |
Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Male
Fluid administration Diabetes Insipidus Nephrogenic Thirst Diagnosis Differential 03 medical and health sciences 0302 clinical medicine 030225 pediatrics medicine Intravascular volume status Humans 030212 general & internal medicine Dehydration business.industry Infant General Medicine Nephrogenic diabetes insipidus medicine.disease Anesthesia Shock (circulatory) Pediatrics Perinatology and Child Health Diabetes insipidus Emergency Medicine Vomiting Fluid Therapy medicine.symptom business |
Popis: | Patients affected by nephrogenic diabetes insipidus (NDI) can present with hypernatremic dehydration, and first-line rehydration schemes are completely different from those largely applied in usual conditions determining a mild to severe hypovolemic dehydration/shock. In reporting the case of a patient affected by NDI and presenting with severe dehydration triggered by acute pharyngotonsillitis and vomiting, we want to underline the difficulties in managing this condition. Restoring the free-water plasma amount in patients affected by NDI may not be easy, but some key points can help in the first line management of these patients: (1) hypernatremic dehydration should always be suspected; (2) even in presence of severe dehydration, skin turgor may be normal and therefore the skinfold recoll should not be considered in the dehydration assessment; (3) decreased thirst is an important red flag for dehydration; (4) if an incontinent patient with NDI appears to be dehydrated, it is important to place the urethral catheter to accurately measure urine output and to be guided in parenteral fluid administration; (5) if the intravenous route is necessary, the more appropriate fluid replenishment is 5% dextrose in water with an infusion rate that should slightly exceed the urine output; (6) the 0.9% NaCl solution (10 mL/kg) should only be used to restore the volemia in a shocked NDI patient; and (7) it could be useful to stop indomethacin administration until complete restoration of hydration status to avoid a possible worsening of a potential prerenal acute renal failure. |
Databáze: | OpenAIRE |
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