Diabetes Insipidus in Children
What is diabetes insipidus?
Diabetes insipidus is a condition caused by not enough antidiuretic hormone (ADH) in the body. ADH is also known as vasopressin. This is a hormone that helps the kidneys keep the correct amount of water in the body. The condition is also called “water diabetes.”
ADH controls how much water is in urine that the kidneys make. ADH is secreted by a small gland at the base of the brain called the hypothalamus. It’s stored in the pituitary gland, and then released into the bloodstream when needed. ADH lowers the amount of water the kidneys make into urine. This helps prevent dehydration. With diabetes insipidus, too much water is pulled from the blood by the kidneys. This causes the body to create a lot of watery urine, and leads to thirst.
The disease has 2 types:
Central diabetes insipidus. With this type, not enough ADH is made or secreted. This is most often because of damage to the hypothalamus or pituitary gland. Typical causes include injury to the brain and rare genetic disorders.
Nephrogenic diabetes insipidus. With this type, the kidneys don’t respond normally to ADH. This is most often because of medicines or chronic disorders. Some genetic disorders can affect the kidneys from birth. Other causes of kidney problems include kidney failure, sickle cell disease, and polycystic kidney disease.
What causes diabetes insipidus?
Diabetes insipidus can be caused by conditions such as:
- A hypothalamus gland that doesn’t make enough ADH
- A pituitary gland that doesn’t release enough ADH into the blood
- Damage to the hypothalamus or pituitary gland during surgery or radiation therapy
- Brain injury
- Brain tumor
- Blockage in the arteries leading to the brain
- Inflammation of the brain (encephalitis)
- Inflammation of the membranes that cover the brain and spinal cord (meningitis)
- Family heredity
- Certain medicines such as lithium
Who is at risk for diabetes insipidus?A child is more likely to get diabetes insipidus if he or she has a head injury, brain surgery, a brain tumor, kidney disease, or uses certain medicines such as lithium.
What are the symptoms of diabetes insipidus?
Symptoms can occur a bit differently in each child. They can include:
- Excessive thirst
- Excessive urination
Babies with diabetes insipidus may show signs such as:
- Poor feeding
- Failure to grow
- High fevers
The symptoms of diabetes insipidus can be like other health conditions such as diabetes mellitus. Make sure your child sees his or her healthcare provider for a diagnosis.
How is diabetes insipidus diagnosed?
The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. The healthcare provider may ask you about your child’s daily fluid intake, diet, and bowel and bladder habits. He or she will give your child a physical exam. Your child may also have tests, such as:
Urine tests. For this test, a child will not drink for several hours (or after midnight while asleep). He or she will then urinate twice within 1 hour. The second urine specimen can often diagnose the condition.
Blood test. This is done to measure salt (sodium) levels in the blood.
Water deprivation test. This test is done in the hospital. It checks if dehydration occurs while a child doesn’t eat or drink.
MRI. This test uses a large magnets and a computer to make detailed images of tissues in the body. The test is done to look for problems with the pituitary gland.
How is diabetes insipidus treated?
Treatment depends on the cause. Treating the cause usually treats the diabetes insipidus.
Treatment may be done with synthetic ADH. This may be taken as a pill, injection, or nasal spray. Other treatments include medicines that increase the body to make more ADH. This includes NSAIDs and chlorpropamide.
Your child must also drink plenty of fluids. This is to make up for the amount of fluids lost by the body through excess urine. You may need to watch your child’s fluid intake and urine output.
What are possible complications of diabetes insipidus?
If left untreated, diabetes insipidus can lead to problems in a child such as:
- Brain damage
- Impaired mental function
- Short attention span
- Poor growth
Living with diabetes insipidusDiabetes insipidus can be temporary or permanent. It depends on what is causing the disease. By managing his or her condition, a child with central diabetes insipidus can lead a full, healthy life. A child with nephrogenic diabetes insipidus can lead a relatively normal life with proper medical care, especially if the medical care is started early. Work with your child's healthcare providers to create an ongoing plan to manage your child’s condition.
When should I call my child's healthcare provider?Talk with your child's healthcare provider if your child drinks and urinates a lot.
Key points about diabetes insipidus
- Diabetes insipidus is a condition caused by not enough antidiuretic hormone (ADH) in the body. This is a hormone that helps the kidneys keep the correct amount of water in the body.
- ADH lowers the amount of water the kidneys make into urine. This helps prevent dehydration. With diabetes insipidus, too much water is pulled from the blood by the kidneys. This causes the body to create a lot of watery urine, and leads to thirst.
- The diabetes insipidus has 2 types: central and nephrogenic. Each acts differently, and has different causes.
- Symptoms can include excessive thirst and urination.
- Your child may have a urine test, blood test, and a water deprivation test.
- Treatment may be done with synthetic ADH. This may be taken as a pill, injection, or nasal spray. Other treatments include medicines that increase the body to make more ADH.
- If left untreated, diabetes insipidus can lead to problems in a child such as brain damage and poor growth.
- With treatment, a child with diabetes insipidus can lead a full, healthy life.
Next stepsTips to help you get the most from a visit to your child’s health care provider:
- Before your visit, write down questions you want answered.
- At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.