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Central diabetes insipidus misdiagnosed as acute gastroenteritis in a pediatric patient

Published online by Cambridge University Press:  21 May 2015

Laleh Gharahbaghian ,
Shahram Lotfipour ,
Christopher E. McCoy ,
Wirachin Hoonpongsimanont  and
Mark Langdorf
Laleh Gharahbaghian
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, Calif.
Shahram Lotfipour*
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, Calif.
Christopher E. McCoy
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, Calif.
Wirachin Hoonpongsimanont
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, Calif.
Mark Langdorf
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, Calif.
*
Department of Emergency Medicine, 101 The City Dr., Rte. 128-01, Orange CA 92868; shl@uci.edu

Abstract

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This case report describes an unusual presentation of nausea, vomiting and diarrhea, which was misdiagnosed as acute gastroenteritis in a 6-year-old girl. The patient later returned to the emergency department (ED) with severe dehydration from idiopathic central diabetes insipidus (DI). At her first visit, this previously healthy patient presented with mild dehydration, signs of acute gastroenteritis and normal urine output. Her brother had experienced similar symptoms a few days earlier. She tolerated an oral fluid challenge and was discharged from the ED with stable vital signs. Two days later, the patient returned with severe dehydration, resolving diarrhea and persistent vomiting. She was admitted to the pediatric intensive care unit. Magnetic resonance imaging illustrated an absent posterior pituitary enhancing signal, which demonstrated a loss of function in that region. There were no other abnormalities. The patient subsequently received desmopressin with improving clinical status and was discharged on the eighth hospital day. DI is a rare disease, but can be fatal if left undiagnosed. It should, therefore, be considered in the differential diagnosis of a dehydrated patient with an unexpectedly low urine specific gravity.

Keywords

diabetes insipidusdehydrationpediatricgastroenteritis
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 5 , September 2008 , pp. 488 - 492
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Ahrens, W.Fluid and electrolyte therapy. In: Tintinalli, JE, Kelen, GD, Stapczynski, JS, et al.Emergency medicine: a comprehensive study guide. 6th ed. New York (NY): McGraw-Hill; 2004. p. 158–159.Google Scholar
2.Charmandari, E, Brook, CG.20 years of experience in idiopathic central diabetes insipidus. Lancet 1999;353:2212–3.Google Scholar
3.Makaryus, AN, McFarlane, SI.Diabetes insipidus: diagnosis and treatment of a complex disease. Cleve Clin J Med 2006;73:65–71.Google Scholar
4.Baylis, PH, Cheetham, T.Diabetes insipidus. Arch Dis Child 1998;79:84–9.CrossRefGoogle ScholarPubMed
5.Molina, PE.Anterior pituitary gland. In: Endocrine physiology, 2nd ed. New York (NY): McGraw-Hill; 2006.Google Scholar
6.Rose, BD, Post, TW.Hyperosmolal states – hypernatremia. In: Clinical physiology of acid-base and electrolyte disorders, 5th ed. New York (NY): McGraw-Hill; 2001. p. 751–4.Google Scholar
7.Kimmel, DW, O’Neil, BP.Systemic cancer presenting as diabetes insipidus: Clinical and radiographic features of 11 patients with a review of metastatic-induced diabetes insipidus. Cancer 1983;52:2355.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
8.Ikema, T, Takasu, N.Serial T1-weighted magnetic resonance imaging changes in a patient with central diabetes insipidus, possibly due to lymphocytic infundibuloneurohypophysitis. Eur J Endocrinol 2005;153:989–90.CrossRefGoogle Scholar
9.Pivonello, R, De Bellis, A, Faggiano, A, et al.Central diabetes in-sipidus and autoimmunity: relationship between the occurrence of antibodies to arginine vasopressin-secreting cells and clinical, immunological, and radiological features in a large cohort of patients with central diabetes insipidus of known and unknown etiology. J Clin Endocrinol Metab 2003;88:1629–36.Google Scholar
10.Cooperman, M.Diabetes insipidus. Available: http://imedicine .com/DisplayTopic.asp?bookid=6&topic=543 (accessed 2007 Jan 14).Google Scholar
11.Ozata, M, Tayfun, C, Ketaran, K, et al.Magnetic resonance imaging of posterior pituitary for evaluation of the neurohypophyseal function in idiopathic and autosomal dominant neurohypophy-seal diabetes insipidus. Eur Radiol 1997;7:1098–102.Google Scholar
12.Kim, RJ, Malattia, C, Allen, M, et al.Vasopressin and desmopressin in central diabetes insipidus: adverse effects and clinical considerations. Pediatr Endocrinol Rev 2004;1:115–23.Google Scholar