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Central (cranial) diabetes insipidus

It results from vasopressin (ADH) deficiency due to many causes.

Clinical suspicion

Suspect when polyuria and nocturia are not accompanied by diabetes mellitus.

Diagnosis

High plasma osmolality and low urine osmolality. Plasma sodium is usually higher than normal.

In cases in which the osmolality levels and the sodium levels are equivocal then a water deprivation test should be conducted.

Again in cases where all the above are inconclusive a hypertonic saline infusion test.

Treatment

Desamino-D-arginine vasopressin (DDAVP, desmopressin) is the treatment of choice.

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