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How Does Vasopressin Treat Diabetes Insipidus?

Diabetes Insipidus: Celebrating A Century Of Vasopressin Therapy

Diabetes Insipidus: Celebrating A Century Of Vasopressin Therapy

Diabetes Insipidus: Celebrating a Century of Vasopressin Therapy Laboratory of Diabetes and Diabetes-Related Disorders (S.Q., S.G., J.R.), Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030 Albert Einstein College of Medicine (S.Q., J.R.), Yeshiva University, Bronx, New York 10461 Search for other works by this author on: Laboratory of Diabetes and Diabetes-Related Disorders (S.Q., S.G., J.R.), Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030 James J Peters VA Medical Center (S.G.), Mount Sinai Medical Center Health System, Bronx, New York 10029 Search for other works by this author on: Hpital du Sacr-Coeur de Montral (D.G.B.), Groupe des Protines Membranaires, Universit de Montral, Montral, Qubec, Canada H4J IC5 Search for other works by this author on: Laboratory of Diabetes and Diabetes-Related Disorders (S.Q., S.G., J.R.), Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York 11030 Albert Einstein College of Medicine (S.Q., J.R.), Yeshiva University, Bronx, New York 10461 Hofstra North Shore-Long Island Jewish School of Medicine (J.R.), North Shore-Long Island Jewish Health System, Hempstead, New York 11549 Address all correspondence and requests for reprints to: Dr Jesse Roth, MD, FACP, Investigator, Feinstein Institute for Medical Research North Shore-Long Island Jewish Health System Albert Einstein College of Medicine, Yeshiva University, 14937 Powells Cove Boulevard, Whitestone, NY 11357. Endocrinology, Volume 155, Issue 12, 1 December 2014, Pages 46054621, Sana Qureshi, Sneha Galiveeti, Daniel G. Bichet, Jesse Roth; Diabetes Insipidus: Celebrating a Century of Vasopressin Therapy, Continue reading >>

Diabetes Insipidus - Central

Diabetes Insipidus - Central

Diabetes insipidus (DI) is an uncommon condition in which the kidneys are unable to prevent the excretion of water. Diabetes insipidus is a different disease than diabetes, though both share common symptoms excessive urination and thirst. Central diabetes insipidus is a form of DI that occurs when the body has a lower than normal amount of antidiuretic hormone (ADH). ADH is also called vasopressin. ADH is produced in a part of the brain called the hypothalamus. It is then stored and released from the pituitary gland. This is a small gland at the base of the brain. ADH controls the amount of water excreted in urine. Without ADH, the kidneys do not work properly to keep enough water in the body. The result is a rapid loss of water from the body in the form of dilute urine. This results in the need to drink large amounts of water due to extreme thirst and to make up for excessive water loss in the urine (as much as 4 gallons or 15 liters a day). The reduced level of ADH may be caused by damage to the hypothalamus or pituitary gland. This damage may be due to surgery, infection, inflammation, tumor, or injury to the brain. Sometimes the cause is unknown. In rare cases, central diabetes insipidus is caused by a genetic problem. Continue reading >>

Ultralow Doses Of Vasopressin In The Management Of Diabetes Insipidus.

Ultralow Doses Of Vasopressin In The Management Of Diabetes Insipidus.

Ultralow doses of vasopressin in the management of diabetes insipidus. Chanson P, Jedynak CP, Dabrowski G, Rohan JE, Bouchama A, de Rohan-Chabot P,Loirat P. Management of postoperative diabetes insipidus (DI) frequently requiresintermittent treatment with multiple subcutaneous injections of pituitrin orvasopressin, in doses averaging 20 IU/24 h. Use of a syringe pump for acontinuous infusion of ultralow doses of pituitrin produced uniform, constant,and sustained reduction of urinary output, thus facilitating regular fluidreplacement. Twelve patients with postoperative DI received iv pituitrin at adose of 1.6 +/- 0.26 mIU/kg X h (1 to 2 IU/24 h). The antidiuretic effect beganat the third hour of treatment, peaked by the sixth hour (diuresis of 37 ml/h,specific gravity of 1.018 +/- 0.002), and was sustained throughout infusion.Polyuria recurred 3 h after the infusion was discontinued; this rapidreversibility is highly advantageous when excessive fluid intake causesoverhydration. Pressor effects were not observed during the treatment period. Continue reading >>

Vasopressin

Vasopressin

Generic Name: vasopressin (VAY soe PRES in) Brand Name: Vasostrict, Pitressin What is vasopressin? Vasopressin is a man-made form of a hormone called "anti-diuretic hormone" that is normally secreted by the pituitary gland. Vasopressin acts on the kidneys and blood vessels. Vasopressin helps prevent loss of water from the body by reducing urine output and helping the kidneys reabsorb water into the body. Vasopressin also raises blood pressure by narrowing blood vessels. Vasopressin is used to treat diabetes insipidus, which is caused by a lack of a naturally occurring pituitary hormone in the body. Vasopressin is also used to treat or prevent certain conditions of the stomach after surgery or during abdominal x-rays. Vasopressin may also be used for purposes not listed in this medication guide. Important Information Follow your doctor's instructions about the amount of liquids you should drink during your treatment with vasopressin. In some cases, drinking too much liquid can be as unsafe as not drinking enough. Before taking this medicine You should not be treated with vasopressin if you are allergic to it. To make sure vasopressin is safe for you, tell your doctor if you have: coronary artery disease (hardened arteries); congestive heart failure; kidney disease; asthma; migraine headaches; or epilepsy or other seizure disorder. Tell your doctor if you are pregnant. Vasopressin can cause premature labor contractions if you receive this medicine during the second or third trimester of pregnancy. It is not known whether vasopressin passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby. How is vasopressin given? Vasopressin is injected into a muscle or under the skin, or into a vein through an IV. A healthcare provid Continue reading >>

Vasopressin Bolus Protocol Compared To Desmopressin (ddavp) For Managing Acute, Postoperative Central Diabetes Insipidus And Hypovolemic Shock

Vasopressin Bolus Protocol Compared To Desmopressin (ddavp) For Managing Acute, Postoperative Central Diabetes Insipidus And Hypovolemic Shock

Vasopressin Bolus Protocol Compared to Desmopressin (DDAVP) for Managing Acute, Postoperative Central Diabetes Insipidus and Hypovolemic Shock 1Department of Neurology, University of Missouri, Columbia, MO, USA 2Department of Pharmacy, University of Missouri, Columbia, MO, USA 3Department of Neurosurgery, University of Missouri, Columbia, MO, USA Correspondence should be addressed to Christopher R. Newey Received 30 November 2016; Accepted 20 December 2016; Published 3 January 2017 Copyright 2017 Anukrati Shukla et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Management of postoperative central diabetes insipidus (DI) can be challenging from changes in volume status and serum sodium levels. We report a case successfully using a dilute vasopressin bolus protocol in managing hypovolemic shock in acute, postoperative, central DI. Case Report. Patient presented after bifrontal decompressive craniotomy for severe traumatic brain injury. He developed increased urine output resulting in hypovolemia and hypernatremia. He was resuscitated with intravenous fluids including a dilute vasopressin bolus protocol. This protocol consisted of 1 unit of vasopressin in 1 liter of 0.45% normal saline. This protocol was given in boluses based on the formula: urine output minus one hundred. Initial serum sodium was 148 mmol/L, and one-hour urine output was 1 liter. After 48 hours, he transitioned to 1-desamino-8-D-arginine vasopressin (DDAVP). Pre-DDAVP serum sodium was 149 mmol/L and one-hour urine output 320 cc. Comparing the bolus protocol to the DDAVP protocol, the average sodium was 143.8 3.2 and 149 Continue reading >>

A Vasopressin Analogue In Treatment Of Diabetes Insipidus

A Vasopressin Analogue In Treatment Of Diabetes Insipidus

Abstract Six children, 3 adolescents, and 3 adults with vasopressin-sensitive diabetes insipidus were treated with a vasopressin analogue, DDAVP (1-deamino-8-D-arginine vasopressin), at a daily dose ranging from 5 to 20 μg administered twice a day intranasally. The period of follow-up of these patients has been from 3 months to 1 year. DDAVP was effective in maintaining normal diuresis and normal urine concentration during both day and night. No local or vasopressor side effects were observed. Compared to other antidiuretic drugs, such as nasal pitressin powder, lysine-vasopressin nasal spray, or pitressin tannate injections, used previously by the patients, DDAVP proved to be superior in the control of the diabetes insipidus and in the subjective feeling of the patients. It is concluded that DDAVP is the drug of choice in the treatment of vasopressinsensitive diabetes insipidus. Full text Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (532K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. These references are in PubMed. This may not be the complete list of references from this article. Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Diabetes insipidus (DI) is a condition characterized by large amounts of dilute urine and increased thirst.[1] The amount of urine produced can be nearly 20 liters per day.[1] Reduction of fluid has little effect on the concentration of the urine.[1] Complications may include dehydration or seizures.[1] There are four types of DI, each with a different set of causes.[1] Central DI (CDI) is due to a lack of the hormone vasopressin (antidiuretic hormone).[1] This can be due to damage to the hypothalamus or pituitary gland or genetics.[1] Nephrogenic diabetes insipidus (NDI) occurs when the kidneys do not respond properly to vasopressin.[1] Dipsogenic DI is due to abnormal thirst mechanisms in the hypothalamus while gestational DI occurs only during pregnancy.[1] Diagnosis is often based on urine tests, blood tests, and the fluid deprivation test.[1] Diabetes mellitus is a separate condition with an unrelated mechanism, though both can result in the production of large amounts of urine.[1] Treatment involves drinking sufficient fluids to prevent dehydration.[1] Other treatments depend on the type.[1] In central and gestational disease treated is with desmopressin.[1] Nephrogenic disease may be treated by addressing the underlying cause or the use of a thiazide, aspirin, or ibuprofen.[1] The number of new cases of diabetes insipidus each year is 3 in 100,000.[4] Central DI usually starts between the ages of 10 and 20 and occurs in males and females equally.[2] Nephrogenic DI can begin at any age.[3] The term "diabetes" is derived from the Greek word meaning siphon.[5] Signs and symptoms[edit] Excessive urination and extreme thirst and increased fluid intake (especially for cold water and sometimes ice or ice water) are typical for DI.[6] The symptoms of excessive urination Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

During the day, your kidneys filter all your blood many times. Normally, most of the water is reabsorbed, and only a small amount of concentrated urine is excreted. DI occurs when the kidneys cannot concentrate the urine normally, and a large amount of dilute urine is excreted. The amount of water excreted in the urine is controlled by antidiuretic hormone (ADH). ADH is also called vasopressin. ADH is produced in a part of the brain called the hypothalamus. It is then stored and released from the pituitary gland. This is a small gland just below the base of the brain. DI caused by a lack of ADH is called central diabetes insipidus. When DI is caused by a failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus. Nephrogenic means related to the kidney. Central DI can be caused by damage to the hypothalamus or pituitary gland as a result of: Head injury Infection Loss of blood supply to the pituitary gland Surgery Nephrogenic DI involves a defect in the kidneys. As a result, the kidneys do not respond to ADH. Like central DI, nephrogenic DI is very rare. Nephrogenic DI may be caused by: Certain drugs, such as lithium Genetic problems Continue reading >>

Vasopressin And Desmopressin In Central Diabetes Insipidus: Adverse Effects Andclinical Considerations.

Vasopressin And Desmopressin In Central Diabetes Insipidus: Adverse Effects Andclinical Considerations.

1. Pediatr Endocrinol Rev. 2004 Nov;2 Suppl 1:115-23. Vasopressin and desmopressin in central diabetes insipidus: adverse effects andclinical considerations. Kim RJ(1), Malattia C, Allen M, Moshang T Jr, Maghnie M. (1)Division of Endocrinology (R.J.K, T.M.), Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA. The management of central diabetes insipidus has been greatly simplified by theintroduction of desmopressin (DDAVP). Its ease of administration, safety andtolerability make DDAVP the first line agent for outpatient treatment of central diabetes insipidus. The major complication of DDAVP therapy is water intoxicationand hyponatremia. The risk of hyponatremia can be reduced by careful dosetitration when initiating therapy and by close monitoring of serum osmolalitywhen DDAVP is used with other medications affecting water balance. Herein wereview the adverse effects of DDAVP and its predecessor, vasopressin, as well as discuss important clinical considerations when using these agents to treatcentral diabetes insipidus. Continue reading >>

Pitressin (vasopressin) Drug Side Effects, Interactions, And Medication Information On Emedicinehealth.

Pitressin (vasopressin) Drug Side Effects, Interactions, And Medication Information On Emedicinehealth.

Vasopressin is a man-made form of a hormone called "anti-diuretic hormone" that is normally secreted by the pituitary gland. In the body, vasopressin acts on the kidneys and blood vessels. Vasopressin helps prevent the loss of water from the body by reducing urine output and helping the kidneys reabsorb water in the body. Vasopressin also raises blood pressure by constricting (narrowing) blood vessels. Vasopressin is used to treat diabetes insipidus, which is caused by a lack of this naturally occurring pituitary hormone in the body. Vasopressin is also used to treat or prevent certain conditions of the stomach after surgery or during abdominal x-rays . Vasopressin may also be used for purposes other than those listed in this medication guide. What are the possible side effects of vasopressin (Pitressin)? Some people receiving vasopressin have had an immediate reaction to the medication. Tell your caregiver right away if you feel weak, nauseated, light-headed, sweaty, or have a fast heartbeat, chest tightness, or weak breathing just after receiving vasopressin. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers at once if you have any of these serious side effects: chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; tingling or loss of feeling in your hands or feet; Less serious side effects may be more likely to occur, such as: Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088. What is the most important information I should know abo Continue reading >>

Nephrogenic Diabetes Insipidus

Nephrogenic Diabetes Insipidus

Not to be confused with Neurogenic diabetes insipidus. Nephrogenic diabetes insipidus (also known as renal diabetes insipidus) is a form of diabetes insipidus primarily due to pathology of the kidney. This is in contrast to central/neurogenic diabetes insipidus, which is caused by insufficient levels of antidiuretic hormone (ADH, that is, arginine vasopressin or AVP). Nephrogenic diabetes insipidus is caused by an improper response of the kidney to ADH, leading to a decrease in the ability of the kidney to concentrate the urine by removing free water. Signs and symptoms[edit] The clinical manifestation is similar to neurogenic diabetes insipidus, presenting with excessive thirst and excretion of a large amount of dilute urine. Dehydration is common, and incontinence can occur secondary to chronic bladder distension.[1] On investigation, there will be an increased plasma osmolarity and decreased urine osmolarity. As pituitary function is normal, ADH levels are likely to be abnormal or raised. Polyuria will continue as long as the patient is able to drink. If the patient is unable to drink and is still unable to concentrate the urine, then hypernatremia will ensue with its neurologic symptoms.[citation needed] Causes[edit] Acquired[edit] Nephrogenic DI (NDI) is most common in its acquired forms, meaning that the defect was not present at birth. These acquired forms have numerous potential causes. The most obvious cause is a kidney or systemic disorder, including amyloidosis,[2] polycystic kidney disease,[3] electrolyte imbalance,[4][5] or some other kidney defect.[2] The major causes of acquired NDI that produce clinical symptoms (e.g. polyuria) in the adult are lithium toxicity and high blood calcium. Chronic lithium ingestion – appears to affect the tubules by enterin Continue reading >>

Diabetes Insipidus Treatment & Management

Diabetes Insipidus Treatment & Management

Approach Considerations Fluid replacement Most patients with diabetes insipidus (DI) can drink enough fluid to replace their urine losses. When oral intake is inadequate and hypernatremia is present, replace losses with dextrose and water or an intravenous (IV) fluid that is hypo-osmolar with respect to the patient’s serum. Do not administer sterile water without dextrose intravenously, as it can cause hemolysis. To avoid hyperglycemia, volume overload, and overly rapid correction of hypernatremia, fluid replacement should be provided at a rate no greater than 500-750 mL/h. A good rule of thumb is to reduce serum sodium by 0.5 mmol/L (0.5 mEq/L) every hour. The water deficit may be calculated on the basis of the assumption that body water is approximately 60% of body weight. Desmopressin and other drugs In patients with central DI, desmopressin is the drug of choice. [31, 32] A synthetic analogue of antidiuretic hormone (ADH), desmopressin is available in subcutaneous, IV, intranasal, and oral preparations. [33] Generally, it can be administered 2-3 times per day. Patients may require hospitalization to establish fluid needs. Frequent electrolyte monitoring is recommended during the initial phase of treatment. Alternatives to desmopressin as pharmacologic therapy for DI include synthetic vasopressin and the nonhormonal agents chlorpropamide, carbamazepine, clofibrate (no longer on the US market), thiazides, and nonsteroidal anti-inflammatory drugs (NSAIDs). Because of side effects, carbamazepine is rarely used, being employed only when all other measures prove unsatisfactory. NSAIDs (eg, indomethacin) may be used in nephrogenic DI, but only when no better options exist. In central DI, the primary problem is a hormone deficiency; therefore, physiologic replacement with Continue reading >>

Diabetes Insipidus Medication

Diabetes Insipidus Medication

Medication Summary Treatment for diabetes insipidus (DI) varies with the form of the disorder. In central DI and most cases of gestational DI, the primary problem is a deficiency of antidiuretic hormone (ADH)—also known as arginine vasopressin (AVP)—and therefore, physiologic replacement with desmopressin is usually effective. A nonhormonal drug can be used if response is incomplete or desmopressin is too expensive. Desmopressin has no role in the treatment of nephrogenic DI or primary polydipsia. Nonhormonal drugs usually are more effective in treating nephrogenic DI. Continue reading >>

Treatment Of Central Diabetes Insipidus

Treatment Of Central Diabetes Insipidus

INTRODUCTION The major symptoms of central diabetes insipidus (DI) are polyuria, nocturia, and polydipsia due to the concentrating defect. Treatment of this disorder is primarily aimed at decreasing the urine output, usually by increasing the activity of antidiuretic hormone (ADH, also called arginine vasopressin or AVP). Replacement of previous and ongoing fluid losses is also important. Most patients with central DI have a normal or only mildly elevated plasma sodium concentration because concurrent stimulation of thirst minimizes the degree of net water loss. However, hypernatremia can occur if thirst is impaired or the patient has no access to water [1-3]. Correction of the hypernatremia requires repair of this free water deficit. (See "Treatment of hypernatremia".) The treatment of central DI will be reviewed here. The causes of this disorder and the approach to the patient with polyuria are discussed separately. (See "Clinical manifestations and causes of central diabetes insipidus" and "Diagnosis of polyuria and diabetes insipidus".) CHOICE OF THERAPY There are three main options for the treatment of polyuria in patients with central DI: Desmopressin, which is an ADH analog and is the preferred drug in almost all patients. Continue reading >>

Nephrogenic Diabetes Insipidus

Nephrogenic Diabetes Insipidus

In nephrogenic diabetes insipidus, the kidneys produce a large volume of dilute urine because the kidney tubules fail to respond to vasopressin (antidiuretic hormone) and are unable to reabsorb filtered water back into the body. Often nephrogenic diabetes insipidus is hereditary, but it can be caused by drugs or disorders that affect the kidneys. To treat nephrogenic diabetes insipidus, people restrict salt in their diet and sometimes take drugs to reduce the amount of urine excreted. Both diabetes insipidus and the better-known type of diabetes, diabetes mellitus, result in the excretion of large volumes of urine. Otherwise, the two types of diabetes are very different. Two types of diabetes insipidus exist. Nephrogenic diabetes insipidus and diabetes mellitus are very different, except that both cause people to excrete large amounts of urine. Causes Normally, the kidneys adjust the concentration and amount of urine according to the body’s needs. The kidneys make this adjustment in response to the level of vasopressin in the blood. Vasopressin, which is secreted by the pituitary gland, signals the kidneys to conserve water and concentrate the urine. In nephrogenic diabetes insipidus, the kidneys fail to respond to the signal. Nephrogenic diabetes insipidus may be Hereditary nephrogenic diabetes insipidus In hereditary nephrogenic diabetes insipidus, the gene that typically causes the disorder is recessive and carried on the X chromosome, one of the two sex chromosomes, so usually only males develop symptoms. However, females who carry the gene can transmit the disease to their sons. Rarely, another abnormal gene can cause nephrogenic insipidus in both males and females. Acquired nephrogenic diabetes insipidus Symptoms People may pass from 1 to 6 gallons (3 to 20 lite Continue reading >>

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