Abstract
Some children with central diabetes insipidus (DI) may lelease ADH under certain conditions. We have studied 10 patients with central DI ranging in age from 3 to 18 years. Their evaluation included a dehydration test and a trial of clofibrate therapy.
During the dehydration test, hourly plasma and urine osmolalities (Posm & Uosm) were measured. When there was a plateau in Uosm, the patients received aq. Pitressin. Greater than a 9% rise in Uosm one hour later confirmed the diagnosis of DI. Four patients had a Uosm higher than their Posm revealing releasable ADH. This occurred with marked thirst associated with an elevatec Posm. When the Posm exceeded 290 mOsm/1, the relationship of Uosm to Posm was always subnormal in our patients when compared to values obtained in 127 normal subjects. By comparing simultaneous Uosm and Posm values, the diagnosis of DI can be strongly suspected; and, the diagnosis will not be missed even in patients with DI who can release ADH when moderately dehydrated.
The 10 patients received clofibrate (500 mg q6h) for 3 to 7 days. Eight patients concentrated their urine 50 to 400% higher than previous levels during random hydration periods. These increases in Uosm were associated with decreases in daily urine volumes. Because Posm measurements during the trial of clofibrate were the same or even lower than during random conditions, we attributed this finding also to the presence of releasable ADH in most pediatric patients with central DI.
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Richman, R., Notman, D., Moses, A. et al. 335 DEHYDRATION STUDIES AND RESPONSES TO CLOFIBRATE IN PEDIATRIC PATIENTS WITH DIABETES INSIPIDUS. Pediatr Res 12 (Suppl 4), 419 (1978). https://doi.org/10.1203/00006450-197804001-00340
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DOI: https://doi.org/10.1203/00006450-197804001-00340