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1. Diabetes mellitus/DKA 2. Compulsive water ingestion 3. Medications i.e., mannitol 4. Small volume urine loss as in cystitis, urethritis, etc. Treatment: 1. IV forms (aqueous vasopressin or desmopressin) are used for central DI in acute hypophysectomy or in intensive care settings until able to transition to intranasal forms 2. Monitor urine specific gravity and urine output closely, titrate drip or IV doses appropriately; monitor serum sodium q2-4 hours initially 3. When stable, transition to intranasal DDAVP 5-20 mcg daily (absorption may be poor with rhinitis or sinusitis); oral preparations also available 4. Treat dehydration with oral repletion or if necessary, parental rehydration if severely dehydrated. 5. For nephrogenic DI, a low-osmolar, low-sodium diet should be initiated, and thiazide diuretics administered which increases sodium loss by inhibiting its reabsorption in the cortical tubules Complications: 1. Mental retardation 2. Seizures 3. Nonobstructive functional hydronephrosis and hydroureters 4. Chronic renal insufficiency 5. Life threatening dehydration and its complications Reference: Saborio et al. Diabetes Insipidus. Pediatrics in Review: 21(4) April 2000. B. Neurology Status Epilepticus Definition: 1. A life-threatening medical emergency defined as frequent or prolonged epileptic seizures 2. Many definitions including a continuous seizure lasting longer than 30 minutes or repeating convulsions lasting 30 minutes or longer without recovery of consciousness between them. Current thinking involves shorter periods of time. 3. Onset may be partial or generalized Epidemiology: 1. A common neurologic medical emergency, affecting 65,000 to 150,000 persons in the United States yearly 2. Estimated that 1.3-16% of all patients with epilepsy will develop SE at some point in their lives (in some may be the presenting seizure) 3. More common in childhood than in adults, no sexual predominance 4. Mortality rate is as high as 10%, rising to 50% in elderly patients 5. Many possible etiologies as listed below: Causes of Status Epilepticus Background of Epilepsy •Poor compliance with medication •Recent change in treatment •Barbiturate or benzodiazepine withdrawal •Alcohol or drug abuse •Pseudostatus epilepticus •Underlying infection/fever.
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