Central Diabetes Insipidus — Diagnostic Criteria for Central DI — Clinical Pathway: PICU

Central Diabetes Insipidus (DI)/Arginine Vasopressin Deficiency (AVP-D) Clinical Pathway – PICU

Diagnostic Criteria for Central DI/AVP-D

  • Central diabetes insipidus (DI), also known as Arginine Vasopressin Deficiency (AVP-D) is a condition that results from deficiency of antidiuretic hormone (ADH, or arginine vasopressin)
  • ADH is produced by the hypothalamus and stored in the posterior pituitary gland
  • ADH regulates water balance in the body by altering free water excretion in the urine
  • Deficiency of ADH results in impaired ability to concentrate urine, leading to
    hypernatremic dehydration
Diagnostic Criteria
  • Required criteria for Central DI/AVP-D
    • Polyuria for 2 consecutive hrs
      • Polyuria definition:
        • > 4 mL/kg/hr if weight < 60 kg
        • > 250 mL/hr if weight ≥ 60 kg
        • and
      • Blood sodium level (Serum Na) > 145 mEq/L
  • Exclude other causes of polyuria (see below)
  • Additional supporting criteria:
    • Serum osmolality: > 300 mOsm/kg
    • Urine osmolality: < 300 mOsm/kg
Differential Diagnoses for Polyuria and Hypernatremia
  • Osmotic diuresis secondary to:
    • Hyperglycemia
    • Elevated BUN
    • Mannitol
    • 3% hypertonic saline
  • Normal diuresis
  • Cerebral salt wasting
  • Diuretics
Conditions with High Risk for Central DI/AVP-D
  • Pre-existing diagnosis of central DI/AVP-D
  • Post-op HPA axis surgery
  • Acute brain injury