deamino-arginine-vasopressin and Craniocerebral-Trauma

Topics: Blood Volume; Child; Craniocerebral Trauma; Deamino Arginine Vasopressin; Dehydration; Diabetes Mellitus, Type 1; Diuresis; Female; Humans; Kinetics; Male; Models, Biological; Neurophysins; Osmolar Concentration; Oxytocin; Pituitary Gland, Posterior; Postoperative Complications; Pregnancy; Pregnancy in Diabetics; Thirst; Urine; Vasopressins

Topics: Administration, Intranasal; Amnesia; Arginine Vasopressin; Clinical Trials as Topic; Craniocerebral Trauma; Deamino Arginine Vasopressin; Humans

Diabetes insipidus (DI) is a well documented complication observed after traumatic head injuries. We report a case of hyperacute onset DI in a 19-year-old male who sustained a hypothalamic-pituitary injury when he was stabbed in the head with a 30-cm long thin-bladed knife. At CT, our patient showed significant hemorrhagic contusions of the lower hypothalamus. He developed polydipsia, polyuria, and mild hypernatremia in the Emergency Department. Diagnostic digital subtraction angiography showed a hypervascular congestive pituitary gland with prominent draining veins. On the third day his hypernatremia became severe (183mEq/L). He was managed with parenteral fluids and a regimen of intranasal DDAVP (1-desamino 8-d-arginine vasopressin), leading to improved plasmatic sodium levels, urine output, and urinary specific gravity. In patients presenting with hyperacute posttraumatic DI, emergency room physicians and neurosurgeons should rule out direct injury to the hypothalamus and/or the posterior lobe of the pituitary, and initiate early pharmacological treatment.

Topics: Acute Disease; Brain Injuries; Confusion; Craniocerebral Trauma; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Humans; Hypernatremia; Hypoglycemic Agents; Hypothalamo-Hypophyseal System; Hypothalamus; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Polyuria; Tomography, X-Ray Computed; Wounds, Stab; Young Adult

Topics: Adult; Anticonvulsants; Antidiuretic Agents; Brain; Brain Edema; Craniocerebral Trauma; Craniotomy; Deamino Arginine Vasopressin; Diazepam; Fatal Outcome; Hematoma, Subdural; Humans; Hyponatremia; Intubation, Intratracheal; Male; Nocturnal Enuresis; Phenytoin; Saline Solution, Hypertonic; Seizures; Sodium; Tomography, X-Ray Computed

Topics: Administration, Intranasal; Adult; Craniocerebral Trauma; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Male; Patient Care Planning

We describe a case of diabetes insipidus after head injury in which thirst persisted despite treatment with DDAVP and normal plasma osmolality. Symptoms were only completely relieved when plasma osmolality was below 270 mosmol/kg. We believe that this might have been due to hypothalamic injury causing resetting of the thirst osmostat. To our knowledge, this type of primary polydipsia has not been described before in association with diabetes insipidus following head injury.

Topics: Adult; Craniocerebral Trauma; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Male; Osmolar Concentration; Thirst

Topics: Adult; Amnesia; Arginine Vasopressin; Craniocerebral Trauma; Deamino Arginine Vasopressin; Humans; Male