• In an emergency, most patients can drink enough fluid to replace their urine losses. Replace losses with dextrose and water or IV fluid hyposmolar to the patient's serum. Avoid hyperglycemia, volume overload, and a correction of hypernatremia that is too rapid. A good rule of thumb is to reduce serum sodium by 0.5 mmol/L/h. Water deficit may be calculated based on the assumption that body water is approximately 60% of body weight in kilograms.

• In case of inadequate thirst, desmopressin is the drug of choice. Generally, it can be administered 2-3 times per day. Patients may require hospitalization to establish fluid needs. Frequent electrolyte monitoring is recommended.

• Pharmaceutical therapy for diabetes insipidus includes subcutaneous, nasal, and oral preparations of vasopressin analogues, as well as chlorpropamide, carbamazepine, clofibrate, thiazides, and indomethacin (limited efficacy).

Surgical Care:

• Postoperatively, administer the usual dose of desmopressin to patients with diabetes insipidus and administer (hypotonic) IV fluids to match urine output.

• After pituitary surgery, administer parenteral desmopressin every 12-24 hours, along with adequate fluid to match losses. Follow the specific gravity of the urine and administer the next dose of desmopressin when the specific gravity has fallen to less than 1.008-1.005 with an increase in urine output. When the patient can tolerate oral intake, thirst can become an adequate guide.

Consultations: In the setting of neurosurgery or head trauma, the diagnosis of diabetes insipidus may be obvious and even expected. The intensivists and the nurses who manage the patient acutely are in the best position to treat acutely. In the more subtle forms, and certainly in all chronic forms where therapy is anticipated to be indefinite, the clinical endocrinologist is invaluable to establish the diagnosis and to design therapy.

Diet:

• No specific dietary considerations exist in chronic diabetes insipidus, but the patient should understand the importance of adequate and balanced salt and water intake.

• Patients with diabetes insipidus also must take special precautions, such as when traveling, to be prepared to treat vomiting or diarrhea and to avoid dehydration with exertion or hot weather.