Background: Central diabetes insipidus (DI) is a well-known complication of CNS trauma or tumors, but is a rare complication of hypothermia. Review of the literature reveals scant case reports of DI as a complication of therapeutic hypothermia after cardiopulmonary resuscitation or head injury, but to date there has been no mention of DI resulting from hypothermia alone.
Objective and hypotheses: Severe hypothermia alone may constrict CNS blood flow, mimicking the effects of circulatory cessation leading to DI.
Method: Case report.
Results: We present a perplexing case of central DI in a previously neurologically intact 13-year-old Caucasian male who developed severe spontaneous hypothermia during treatment for antipsychotic induced toxic epidermal necrolysis. Despite aggressive internal and external warming, his core temperature reached a nadir of 85.1 F (29.5°C) while his sodium concentration simultaneously increased. He required ECMO for temperature regulation and while his hypothermia improved his hypernatremia worsened to 164 mEq/l despite fluid resuscitation. Initial septic work-up for hypothermia was negative. Interesting within 48 h of starting vasopressin for mild hypotension, he became eunatremic. However, when vasopressin was discontinued, his hypernatremia returned to 152 mEq/l with a serum osmolality of 332 mOsm/kg, an inappropriate urine osmolality of 400 mOsm/kg, and an inappropriately normal antidiuretic hormone level of 8.8 pg/ml (1.013.3). He did experienced intermittent polyuria while off vasopressin. Additional pituitary workup revealed a normal cortrosyn stimulation test and thyroid function tests.
Conclusion: Given these findings, he was diagnosed with partial DI and his sodium only began to normalize after oral desmopressin was initiated. Unlike previous case reports citing hypothermia related DI, our case is not confounded by an inciting anoxic event. This unusual case encourages investigation into the role hypothermia may play in disrupting neuroendocrine functioning in pediatric patients.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology