Rivkees Scott A, Dunbar Nancy, Wilson Thomas A
Department ofPediatrics, Yale Child Health Research Center, Section of Pediatric Endocrinology, Yale University, New Haven, CT, USA.
J Pediatr Endocrinol Metab. 2007 Apr;20(4):459-69. doi: 10.1515/jpem.2007.20.4.459.
Infants consume most of their calories as formula. Because of this large fluid intake, infants normally produce dilute urine, not far off from that seen in individuals with diabetes insipidus (DI). Infants with DI are therefore prone to water intoxication if fixed antidiuresis is achieved using the long-acting vasopressin analog desmopressin (DDAVP), which induces a state of high urine concentration. DI treatment approaches applied to older children and adults, who consume the their calories as solids, are difficult to apply to infants with DI. When used in infants, oral and intranasal DDAVP can be associated with wide swings in serum sodium concentration (SNA). In comparison, precisely administered subcutaneous doses of DDAVP can be successfully used in infants with DI, and appear to be superior to oral or intranasal DDAVP therapy. Alternatively, consistent eunatremia can be simply achieved in infantile DI using low renal solute load (RSL) formula and thiazide diuretics. Low RSL formula reduces obligatory urinary water losses, and thiazide diuretics concentrate the urine to levels seen in normal formula-fed infants. This report addresses treatment options of DI in infancy and the delicate management issues involved.
婴儿摄入的大部分热量来自配方奶。由于液体摄入量较大，婴儿通常会产生稀释尿液，与尿崩症（DI）患者的尿液情况相差不大。因此，如果使用长效血管加压素类似物去氨加压素（DDAVP）实现固定抗利尿作用，从而诱导高尿浓缩状态，患有DI的婴儿就容易发生水中毒。应用于年龄较大儿童和成人（他们以固体形式摄入热量）的DI治疗方法很难应用于患有DI的婴儿。在婴儿中使用时，口服和鼻内给予DDAVP可能会导致血清钠浓度（SNA）大幅波动。相比之下，精确给予皮下剂量的DDAVP可成功用于患有DI的婴儿，且似乎优于口服或鼻内DDAVP治疗。或者，使用低肾溶质负荷（RSL）配方奶和噻嗪类利尿剂可在婴儿DI中简单地实现持续正常血钠浓度。低RSL配方奶可减少必需的尿水流失，噻嗪类利尿剂可将尿液浓缩至正常配方奶喂养婴儿的水平。本报告阐述了婴儿期DI的治疗选择以及所涉及的精细管理问题。
