ESPE Abstracts

Background: Experience with nasogastric administration of oral DDAVP [desamino-D-arginine-8-vasopressin] lyophilisate (ODL) for central diabetes insipidus (CDI) in disabled children with swallowing coordination difficulties is limited.

Objective: We aimed to assess the safety and efficacy of nasogastric use of ODL in disabled children with CDI.

Methods: Clinical, laboratory and neuroimaging characteristics of twelve disabled children with CDI treated with ODL through nasogastric tube between 2012 and 2022 were evaluated.

Results: Six boys and six girls with a mean (± sd) age of 43 (±40) months were evaluated (Table 1). These children [mean weight (± sd) 17 (±13) kg; mean height (±sd) 93 (±30) cm] presented with failure to thrive, irritability, prolonged fever, polyuria and hypernatremia [mean serum sodium 162 (± 3.6) mEq/L]. At the time of hypernatremia, mean serum and urine osmolality were 321 (± 14) mOsm/kg and 105 (± 7.8) mOsm/kg, respectively. ADH levels were undetectable (<0.5 pmol/L) at admission in all cases. Nasogastric tube administration of DDAVP lyophilisate (120 µg/tablet) dissolved in water (10 ml) was initiated at a dose of 1-5 µg/kg/day in two divided doses together with controlled water intake to avoid hyponatremia. The frequency and dose of DDAVP were adjusted based on urine output and serum sodium concentration. Serum sodium normalised in a mean duration of 122.4 ± 10.6 hours with a mean decline rate of 0.52 ± 0.14 mEq/L/hour. Three children needed rehospitalization because of hypernatremia due to unintentional DDAVP omission by caregivers. No episode of hyponatremia was observed. Weight gain and growth were normal during the median follow-up duration of 4.5 years.

Conclusions: Nasogastric administration of oral DDAVP lyophilised formulation was safe and effective in the treatment of CDI in disabled children in this small retrospective series.