Central Diabetes Insipidus — Triple Phase Response — Clinical Pathway: PICU

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

Triple Phase Response

The triple phase, or triphasic, response refers to the transition through the following:

  • Polyuric phase
  • Transient Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
  • Chronic diabetes insipidus/AVP-D

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Phase of Triple Phase Response

Cause Leakage of ADH from damaged posterior pituitary and severed axons from hypothalamic ADH-secreting neurons
Children at High Risk Post-pituitary surgery
Assessment
  • Titrate vasopressin to maintain UOP in goal range.
  • Hold vasopressin if hyponatremic.
  • If vasopressin has been discontinued and sodium remains low, assess fluid status, urine osms, and urine sodium to evaluate for SIADH.
Diagnostic Criteria
  • Child no longer receiving vasopressin or desmopressin, and:
    • Blood sodium level (Serum Na) < 135
      • Corrected for hyperglycemia if present
    • Urine osms > 100 and
    • Urine Na > 40
Intervention Typical SIADH management includes fluid restriction.