Central diabetes insipidus and chemotherapy: use of a continuous arginine vasopressin infusion for fluid and sodium balance

Joshua A. Levine, Susan L. Karam, Clare O’Connor, Smita Kumar, Malini Soundarrajan, Deepika McConnell, Abeer T Ammar, Ashley M Gale, Donald Zimmerman, Emily D Szmuilowicz

Research output: Contribution to journalArticle

Abstract

Objective: Central diabetes insipidus can occur in the setting of primary or metastatic tumors that disrupt the hypothalamic-pituitary axis. Usual treatment consists of water intake to replace ongoing fluid losses and desmopressin administration aimed at decreasing the urine output to enable maintenance of eunatremia without polyuria. Marked derangement in plasma sodium concentration can occur when high-volume intravenous fluid administration is required during chemotherapy to prevent nephrotoxicity, particularly if obligate fluid intake exceeds the total daily fluid intake necessary to maintain eunatremia.

Methods: We developed a protocol for a rapidly titratable low-dose continuous intravenous arginine vasopressin infusion to maintain eunatremia in patients with central diabetes insipidus during periods of obligate fluid intake.

Results: We successfully maintained eunatremia in 2 patients with central nervous system lymphoma who underwent several cycles of obligate intravenous fluid administration with 5% dextrose in 0.45% sodium chloride for chemotherapy.

Conclusion: Obligate fluid administration can result in dangerous and severe fluctuations in plasma sodium concentration in patients with central diabetes insipidus receiving conventional desmopressin therapy. The use of a rapidly titratable low-dose continuous vasopressin infusion successfully maintained eunatremia in this setting. This protocol can be replicated to prevent the wide and potentially dangerous fluctuations in plasma sodium concentration that can occur in patients with central diabetes insipidus who require high-volume intravenous fluid administration. This protocol has not been assessed among patients with impaired renal function and, thus, may not be generalizable to this population.
Original languageEnglish (US)
Pages (from-to)e487-492
JournalAACE Clinical Case Reports
Volume4
Issue number6
StatePublished - 2018

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Neurogenic Diabetes Insipidus
Water-Electrolyte Balance
Arginine Vasopressin
Sodium
Drug Therapy
Intravenous Administration
Deamino Arginine Vasopressin
Hypothalamic Neoplasms
Polyuria
Water Purification
Vasopressins
Sodium Chloride
Drinking
Lymphoma
Central Nervous System
Maintenance
Urine
Kidney
Glucose
Population

Cite this

Levine, J. A., Karam, S. L., O’Connor, C., Kumar, S., Soundarrajan, M., McConnell, D., ... Szmuilowicz, E. D. (2018). Central diabetes insipidus and chemotherapy: use of a continuous arginine vasopressin infusion for fluid and sodium balance . AACE Clinical Case Reports, 4(6), e487-492.
Levine, Joshua A. ; Karam, Susan L. ; O’Connor, Clare ; Kumar, Smita ; Soundarrajan, Malini ; McConnell, Deepika ; Ammar, Abeer T ; Gale, Ashley M ; Zimmerman, Donald ; Szmuilowicz, Emily D. / Central diabetes insipidus and chemotherapy : use of a continuous arginine vasopressin infusion for fluid and sodium balance . In: AACE Clinical Case Reports. 2018 ; Vol. 4, No. 6. pp. e487-492.
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Levine, JA, Karam, SL, O’Connor, C, Kumar, S, Soundarrajan, M, McConnell, D, Ammar, AT, Gale, AM, Zimmerman, D & Szmuilowicz, ED 2018, 'Central diabetes insipidus and chemotherapy: use of a continuous arginine vasopressin infusion for fluid and sodium balance ', AACE Clinical Case Reports, vol. 4, no. 6, pp. e487-492.

Central diabetes insipidus and chemotherapy : use of a continuous arginine vasopressin infusion for fluid and sodium balance . / Levine, Joshua A.; Karam, Susan L.; O’Connor, Clare; Kumar, Smita; Soundarrajan, Malini; McConnell, Deepika; Ammar, Abeer T; Gale, Ashley M; Zimmerman, Donald; Szmuilowicz, Emily D.

In: AACE Clinical Case Reports, Vol. 4, No. 6, 2018, p. e487-492.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Central diabetes insipidus and chemotherapy

T2 - use of a continuous arginine vasopressin infusion for fluid and sodium balance

AU - Levine, Joshua A.

AU - Karam, Susan L.

AU - O’Connor, Clare

AU - Kumar, Smita

AU - Soundarrajan, Malini

AU - McConnell, Deepika

AU - Ammar, Abeer T

AU - Gale, Ashley M

AU - Zimmerman, Donald

AU - Szmuilowicz, Emily D

PY - 2018

Y1 - 2018

N2 - Objective: Central diabetes insipidus can occur in the setting of primary or metastatic tumors that disrupt the hypothalamic-pituitary axis. Usual treatment consists of water intake to replace ongoing fluid losses and desmopressin administration aimed at decreasing the urine output to enable maintenance of eunatremia without polyuria. Marked derangement in plasma sodium concentration can occur when high-volume intravenous fluid administration is required during chemotherapy to prevent nephrotoxicity, particularly if obligate fluid intake exceeds the total daily fluid intake necessary to maintain eunatremia.Methods: We developed a protocol for a rapidly titratable low-dose continuous intravenous arginine vasopressin infusion to maintain eunatremia in patients with central diabetes insipidus during periods of obligate fluid intake.Results: We successfully maintained eunatremia in 2 patients with central nervous system lymphoma who underwent several cycles of obligate intravenous fluid administration with 5% dextrose in 0.45% sodium chloride for chemotherapy.Conclusion: Obligate fluid administration can result in dangerous and severe fluctuations in plasma sodium concentration in patients with central diabetes insipidus receiving conventional desmopressin therapy. The use of a rapidly titratable low-dose continuous vasopressin infusion successfully maintained eunatremia in this setting. This protocol can be replicated to prevent the wide and potentially dangerous fluctuations in plasma sodium concentration that can occur in patients with central diabetes insipidus who require high-volume intravenous fluid administration. This protocol has not been assessed among patients with impaired renal function and, thus, may not be generalizable to this population.

AB - Objective: Central diabetes insipidus can occur in the setting of primary or metastatic tumors that disrupt the hypothalamic-pituitary axis. Usual treatment consists of water intake to replace ongoing fluid losses and desmopressin administration aimed at decreasing the urine output to enable maintenance of eunatremia without polyuria. Marked derangement in plasma sodium concentration can occur when high-volume intravenous fluid administration is required during chemotherapy to prevent nephrotoxicity, particularly if obligate fluid intake exceeds the total daily fluid intake necessary to maintain eunatremia.Methods: We developed a protocol for a rapidly titratable low-dose continuous intravenous arginine vasopressin infusion to maintain eunatremia in patients with central diabetes insipidus during periods of obligate fluid intake.Results: We successfully maintained eunatremia in 2 patients with central nervous system lymphoma who underwent several cycles of obligate intravenous fluid administration with 5% dextrose in 0.45% sodium chloride for chemotherapy.Conclusion: Obligate fluid administration can result in dangerous and severe fluctuations in plasma sodium concentration in patients with central diabetes insipidus receiving conventional desmopressin therapy. The use of a rapidly titratable low-dose continuous vasopressin infusion successfully maintained eunatremia in this setting. This protocol can be replicated to prevent the wide and potentially dangerous fluctuations in plasma sodium concentration that can occur in patients with central diabetes insipidus who require high-volume intravenous fluid administration. This protocol has not been assessed among patients with impaired renal function and, thus, may not be generalizable to this population.

UR - https://doi.org/10.4158/ACCR-2018-0165

M3 - Article

VL - 4

SP - e487-492

JO - AACE Clinical Case Reports

JF - AACE Clinical Case Reports

SN - 2376-0605

IS - 6

ER -

Levine JA, Karam SL, O’Connor C, Kumar S, Soundarrajan M, McConnell D et al. Central diabetes insipidus and chemotherapy: use of a continuous arginine vasopressin infusion for fluid and sodium balance . AACE Clinical Case Reports. 2018;4(6):e487-492.