Treatment of Diabetes Insipidus

Initial Assessment and Diagnosis

The American Academy of Clinical Endocrinologists recommends measuring serum sodium, serum osmolality, and urine osmolality to establish baseline values and confirm inappropriately dilute urine (typically <200 mOsm/kg H₂O) 1, 3
Plasma copeptin levels distinguish between central and nephrogenic DI: levels <21.4 pmol/L indicate central DI, while levels >21.4 pmol/L suggest nephrogenic DI 3, 4
Genetic testing is recommended early in suspected nephrogenic DI cases, particularly in symptomatic females and male offspring of known carriers 1, 2

Desmopressin is the treatment of choice for central DI and can be administered via multiple routes 1, 2

The European Society of Endocrinology recommends thiazide diuretics combined with prostaglandin synthesis inhibitors for symptomatic infants and children with nephrogenic DI 2
Thiazide diuretics with low-salt diet can reduce diuresis by up to 50% in the short term through mild volume depletion and increased proximal sodium/water reabsorption 2, 3
Prostaglandin synthesis inhibitors (NSAIDs) enhance collecting duct water permeability and should be added to the regimen 2, 3, 5

Free access to fluid is essential in all patients with DI to prevent dehydration, hypernatremia, and associated complications 2, 3
Patients capable of self-regulating should determine fluid intake based on thirst sensation rather than prescribed amounts 2, 3, 4

The American Academy of Pediatrics recommends support from an experienced dietitian to ensure nutritional adequacy and provide practical advice on energy supplementation for infants and young children with DI 2
Tube feeding (nasogastric or gastrostomy) should be considered case-by-case for repeated vomiting/dehydration episodes or growth failure in infants and young children with DI 2