Central Diabetes Insipidus — Medication Guidance — Clinical Pathway: PICU

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

Vasopressin

Vasopressin
Initial Dose 0.5 milli-units/kg/hr
Administration
  • Administer infusion through a central line
  • In emergent situations, peripheral IV is acceptable
  • When administering peripherally, use caution as this drug is a known vesicant
Initial Titration Double dose every 30 mins until the child is no longer polyuric, up to a usual max dose of 10 milli-units/kg/hr*
Maintenance Titration
  • Children receiving > 2 milli-units/kg/hr:
    • Titrate by 1-2 milli-units/kg/hr every 30-60 mins as needed to maintain goal UOP
  • Children receiving ≤ 2 milli-units/kg/hr:
    • Titrate by 0.1 to 0.5 milli-units/kg/hr every 30-60 mins as needed to maintain goal UOP
  • If the child becomes polyuric, return to initial titration
Notes
  • Use care when prescribing and/or administering vasopressin solutions.
  • Give close attention to:
    • Indication
    • Concentration of solution
    • Route of administration
    • Dose
    • Rate of administration (milli-units/kg/hr)
  • *Some children may require higher doses
Desmopressin (DDAVP)
Medication Route PO Intranasal Subcutaneous
Formulation Tablet 0.1 mg Nasal Spray 1 mcg/0.1mL 0.5 mcg/mL
4 mcg/mL
Formulations are not interchangeable
Dosing Dose conversion for desmopressin is not standard
Please review CHOP Formulary and consult Endocrine for dosing recommendations