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Management of Central Diabetes Insipidus in Disabled Children with Diluted Oral Desmopressin Lyophilisate Formulation Administered Through Nasogastric Tube: A Retrospective Case Series

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Abstract

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. Time to serum sodium normalisation was compared with that of children with normal intellect and CDI treated with sublingual DDAVP.

Methods

Clinical, laboratory and neuroimaging characteristics were evaluated for 12 disabled children with CDI treated with ODL through nasogastric tube at Dr Behcet Uz Children's Hospital, Turkey, between 2012 and 2022.

Results

Six boys and six girls with a mean (±SD) age of 43 (± 40) months were evaluated. These children (mean [±SD] weight standard deviation score [SDS] − 1.2 ± 1.7; mean [±SD] height SDS − 1.3 ± 1.4) presented with failure to thrive, irritability, prolonged fever, polyuria and hypernatraemia (mean serum sodium 162 [±3.6] mEq/L). At diagnosis, mean serum and urine osmolality were 321 (± 14) mOsm/kg and 105 (± 7.8) mOsm/kg, respectively. Arginine vasopressin (AVP) levels were undetectable (< 0.5 pmol/L) at diagnosis in all patients. Nasogastric tube administration of DDAVP lyophilisate (120 µg/tablet) dissolved in water (10 mL) was commenced at a dose of 1–5 µg/kg/day in two divided doses together with controlled water intake to avoid hyponatraemia. The frequency and dose of DDAVP were titrated based on urine output and serum sodium concentration. Serum sodium declined at a rate of 0.11 ± 0.03 mEq/L/h and reached normal range in a mean duration of 174 ± 46.5 h. Serum sodium declined faster in children with normal intellect and CDI treated with sublingual DDAVP (1.28 ± 0.39 mEq/L/h; p = 0.0003). Three disabled children needed rehospitalisation because of hypernatraemia due to unintentional DDAVP omission by caregivers. No episode of hyponatraemia was observed. Weight gain and growth were normal during the median (± interquartile range) follow-up duration of 32 ± 67 months.

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.

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Author notes

  1. Hüseyin Anıl Korkmaz, Ved Bhushan Arya have contributed equally to this manuscript.

Authors and Affiliations

  1. Division of Pediatric Endocrinology, Department of Pediatrics, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkey

    Hüseyin Anıl Korkmaz & Behzat Ozkan

  2. Division of Pediatric Endocrinology, Variety Club Children’s Hospital, King’s College Hospital NHS Foundation Trust, London, UK

    Ved Bhushan Arya

  3. Faculty of Medicine and Life Science, King’s College London, London, UK

    Ved Bhushan Arya

  4. Department of Pediatrics, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkey

    Ahmet Gönüllü & Fulya Coşkunol

Authors
  1. Hüseyin Anıl Korkmaz
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Correspondence to Hüseyin Anıl Korkmaz.

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Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Conflict of interest

The authors declare there is no conflict of interest in this paper.

Availability of Data and Material

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethics Approval

The study was approved by the Research Ethics Board of Dr Behcet Uz Children’s Hospital in Turkey. The authors certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to Participate

Written informed consent was obtained from parents of all participants.

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The authors confirm that consent of parents of all participants was obtained to publish the data.

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Authors' Contributions

Concept, Design, Writing and Literature Search: Huseyin Anil Korkmaz, Behzat Ozkan; Data Analysis, Writing and Literature Search: Ved Bhushan Arya; Data Analysis: Ahmet Gönüllü, Fulya Coşkunol; Data collection, Literature research: Fulya Coşkunol. All authors have read and approved the final version of the manuscript, and agree to be accountable for the work.

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Korkmaz, H.A., Arya, V.B., Gönüllü, A. et al. Management of Central Diabetes Insipidus in Disabled Children with Diluted Oral Desmopressin Lyophilisate Formulation Administered Through Nasogastric Tube: A Retrospective Case Series. Pediatr Drugs 25, 595–601 (2023). https://doi.org/10.1007/s40272-023-00578-7

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