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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1756309
Original Article

Diagnosis and Management of New-Onset Central Diabetes Insipidus in Critically Ill Children Varies between Pediatric Critical Care Medicine and Pediatric Endocrinology Clinicians

R. Brandon Hunter 
1   Division of Critical Care Medicine, Texas Children's Hospital, Houston, Texas, United States
,
Herodes Guzman
2   Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Jessica Winters
3   Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
,
Katherine Lord
4   Division of Endocrinology and Diabetes, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
5   Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Matthew Kirschen
2   Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
6   Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
7   Department of Anesthesiology, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Vijay Srinivasan
2   Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
6   Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
7   Department of Anesthesiology, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
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Abstract

The diagnosis and management of central diabetes insipidus in critically ill children is not standardized. Our objective was to characterize differences between Pediatric Critical Care Medicine (PCCM) and Pediatric Endocrinology (PE) clinicians in the diagnosis and management of new-onset CDI in the pediatric intensive care unit. We also sought to characterize knowledge gaps among general pediatrics (GP) residents. This is a scenario-based survey to assess patterns of diagnosis and management of new-onset CDI that was distributed to PCCM, PE, and GP clinicians who work in a quaternary care urban children's hospital. Of 275 PCCM, PE, and GP clinicians surveyed, 158 (57%) responded. More PCCM than PE clinicians relied on serum sodium levels (96 vs. 75%, p <0.01) and more PE than PCCM clinicians relied on serum osmolality (91 vs. 40%, p < .001) for diagnosis. Fewer PCCM than PE clinicians favored restricting IV fluids to two-thirds maintenance rate (4 vs. 37%, p <0.001). More PCCM than PE clinicians favored a starting dose of 0.5 milli-units/kg/h for IV vasopressin infusion (76 vs. 53%, p = 0.048). More PCCM clinicians than PE clinicians favored titrating the IV vasopressin infusion every 20 minutes (24 vs. 2%, p = 0.02), whereas more PE clinicians than PCCM clinicians favored titration every 60 minutes (38 vs. 14%, p = 0.03). GP residents earlier in training had greater self-reported gaps in knowledge. We observed substantial variability in the diagnosis and management of new-onset CDI in critically ill children among PCCM, PE, and GP clinicians. There is a need for greater standardization in care of these patients.

Keywords

pediatrics - critical care - endocrinology - diabetes insipidus - clinical care

Financial Support

None declared.


Supplementary Material



Publication History

Received: 17 May 2022

Accepted: 22 July 2022

Article published online:
14 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Arima H, Azuma Y, Morishita Y, Hagiwara D. Central diabetes insipidus. Nagoya J Med Sci 2016; 78 (04) 349-358
    PubMedGoogle Scholar
  • 2 Kalra S, Zargar AH, Jain SM. et al. Diabetes insipidus: the other diabetes. Indian J Endocrinol Metab 2016; 20 (01) 9-21
    CrossrefPubMedGoogle Scholar
  • 3 Mutter CM, Smith T, Menze O, Zakharia M, Nguyen H. diabetes insipidus: pathogenesis, diagnosis, and clinical management. Cureus 2021; 13 (02) e13523
    PubMedGoogle Scholar
  • 4 Dabrowski E, Kadakia R, Zimmerman D. Diabetes insipidus in infants and children. Best Pract Res Clin Endocrinol Metab 2016; 30 (02) 317-328
    CrossrefPubMedGoogle Scholar
  • 5 Mavrakis AN, Tritos NA. Diabetes insipidus with deficient thirst: report of a patient and review of the literature. Am J Kidney Dis 2008; 51 (05) 851-859
    CrossrefPubMedGoogle Scholar
  • 6 Wise-Faberowski L, Soriano SG, Ferrari L. et al. Perioperative management of diabetes insipidus in children. J Neurosurg Anesthesiol 2004; 16 (03) 220-225
    CrossrefPubMedGoogle Scholar
  • 7 Di Iorgi N, Napoli F, Allegri AEM. et al. Diabetes insipidus—diagnosis and management. Horm Res Paediatr 2012; 77 (02) 69-84
    CrossrefPubMedGoogle Scholar
  • 8 Hui C, Radbel JM. Diabetes Insipidus. StatPearls Publishing. 2021 . Accessed May 12, 2021, at: http://www.ncbi.nlm.nih.gov/pubmed/29262153
    PubMedGoogle Scholar
  • 9 Maghnie M, Cosi G, Genovese E. et al. Central diabetes insipidus in children and young adults. N Engl J Med 2000; 343 (14) 998-1007
    CrossrefPubMedGoogle Scholar
  • 10 Lehrnbecher T, Müller-Scholden J, Danhauser-Leistner I, Sörensen N, von Stockhausen HB. Perioperative fluid and electrolyte management in children undergoing surgery for craniopharyngioma. A 10-year experience in a single institution. Childs Nerv Syst 1998; 14 (06) 276-279
    CrossrefPubMedGoogle Scholar
  • 11 Sperling M. Pediatric Endocrinology. Elsevier; 2014
    Google Scholar
  • 12 Patti G, Ibba A, Morana G. et al. Central diabetes insipidus in children: diagnosis and management. Best Pract Res Clin Endocrinol Metab 2020; 34 (05) 101440
    CrossrefPubMedGoogle Scholar
  • 13 Mishra G, Chandrashekhar SR. Management of diabetes insipidus in children. Indian J Endocrinol Metab 2011; 15 (Suppl. 03) S180-S187
    PubMedGoogle Scholar
  • 14 Adams JR, Blevins Jr LS, Allen GS, Verity DK, Devin JK. Disorders of water metabolism following transsphenoidal pituitary surgery: a single institution's experience. Pituitary 2006; 9 (02) 93-99
    CrossrefPubMedGoogle Scholar
  • 15 de Vries F, Lobatto DJ, Verstegen MJT, van Furth WR, Pereira AM, Biermasz NR. Postoperative diabetes insipidus: how to define and grade this complication?. Pituitary 2021; 24 (02) 284-291
    CrossrefPubMedGoogle Scholar
  • 16 Pratheesh R, Swallow DMA, Rajaratnam S. et al. Incidence, predictors and early post-operative course of diabetes insipidus in paediatric craniopharygioma: a comparison with adults. Childs Nerv Syst 2013; 29 (06) 941-949
    CrossrefPubMedGoogle Scholar
  • 17 Schreckinger M, Szerlip N, Mittal S. Diabetes insipidus following resection of pituitary tumors. Clin Neurol Neurosurg 2013; 115 (02) 121-126
    CrossrefPubMedGoogle Scholar
  • 18 Papadimitriou DT, Spiteri A, Attilakos A, Papadimitriou A. Cerebral salt wasting complicated by central diabetes insipidus and growth hormone deficiency. Indian J Pediatr 2018; 85 (07) 580-581
    CrossrefPubMedGoogle Scholar
  • 19 Wright WL. Sodium and fluid management in acute brain injury. Curr Neurol Neurosci Rep 2012; 12 (04) 466-473
    CrossrefPubMedGoogle Scholar
  • 20 Lambert WA, Paro M, Pinci E. et al. Venous thromboembolism in the setting of pediatric central diabetes insipidus: a systematic review of the literature and report of 2 cases. J Neurosurg Pediatr 2022; 29 (05) 1-10
    CrossrefPubMedGoogle Scholar
  • 21 Seattle Children's Hospital. Werny D, Dervan L. et al. Dysnatremia Pathway. Published online 2018, Accessed April 12, 2022 at: https://www.seattlechildrens.org/pdf/dysnatremia-pathway.pdf
    PubMedGoogle Scholar
  • 22 Kirschen M, Vajravelu M, Lord K, Srinivasan V, Resendiz Trujano K, Hunter RGA. PICU Clinical Pathway for Known or Suspected Central Diabetes Insipidus (DI). Published 2021, Accessed April 12, 2022 at: https://www.chop.edu/clinical-pathway/central-diabetes-insipidus-clinical-pathway
    PubMedGoogle Scholar
  • 23 Edate S, Albanese A. Management of electrolyte and fluid disorders after brain surgery for pituitary/suprasellar tumours. Horm Res Paediatr 2015; 83 (05) 293-301
    CrossrefPubMedGoogle Scholar
  • 24 Mukherjee KK, Dutta P, Singh A. et al. Choice of fluid therapy in patients of craniopharyngioma in the perioperative period: a hospital-based preliminary study. Surg Neurol Int 2014; 5: 105
    CrossrefPubMedGoogle Scholar
  • 25 Zhang AH, Liu XH. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Int J Evid-Based Healthc 2011; 9 (02) 191-192
    CrossrefPubMedGoogle Scholar
  • 26 Sylvester AM, George M. Effect of a clinical pathway on length of stay and cost of pediatric inpatient asthma admissions: an integrative review. Clin Nurs Res 2014; 23 (04) 384-401
    CrossrefPubMedGoogle Scholar
  • 27 Pratheesh R, Swallow DM, Joseph M. et al. Evaluation of a protocol-based treatment strategy for postoperative diabetes insipidus in craniopharyngioma. Neurol India 2015; 63 (05) 712-717
    CrossrefPubMedGoogle Scholar