The diagnosis and management of diabetes insipidus during medical emergencies.

The abrupt presentation of hypertonic polyuria, polydipsia and hypernatremia, reflects vasopressin deficiency owing to multiple potential etiologies. Diabetes insipidus becomes an emergency and leads to severe hyperosmolality and dehydration when fluid intake does not match obligate losses. Decreased mental alertness may impair the ability to sense thirst or to obtain access to fluids, thus placing patients postoperatively or posttrauma at particular risk of complicated diabetes insipidus. Intravenously administered DDAVP and hydration with hypotonic fluids is the preferred therapy in the acute setting. As diabetes insipidus may be of unpredictable duration, the need for ongoing medical therapy must be frequently reassessed.