Central Diabetes Insipidus Due to Parasetamol Induced Subacute Fulminant Liver Failure: Case Report

Abstract

entral diabetes insipidus (CDI) is a clinic condition characterized by polyuria and antidiuretic hormone (ADH) deficiency. Autoimmunity is mostly responsible for the etiology but rarely travma, encephalopathy, surgery and genetic disorders can play role in the etiology. 1Paracetamol intoxication is the most common cause of acute liver failure and the disease associated with encephalopathy. 2 We present a case of neurogenic diabetes insipidus that developed after paracetamol induced subacute fulminant liver failure. CASE REPORTA 20-years-old male patient admitted to emergency room with nausea and vomitting. In history 20 grams of paracetamol intake due to severe headache associated with migraine was present. In laboratory analysis international normalized ratio (INR): 2.65, alanine transferase (ALT):8400 U/L, aspartate transaminase (AST): 4900 U/L, total biluribin: 3 mg/dl, direct biluribin: 1.5 mg/dl, albumine: 3.4 g/dL, sodium: 141 mmol/L, creatinin: 0.8 mg/dl, pH: 7.4, HCO 3 :24 mmol/L were detected. Serum lactate levels were normal. Autoimmune and viral screen results were negative. Physical examination re-vealed grade 2 encephalopathy. An ultrasound scan showed a normal liver. TreatWorld Clin J Med Sci 2017;1(1) 55Central Diabetes Insipidus Due to Parasetamol Induced Subacute Fulminant Liver Failure: Case Report A AB BS ST TR RA AC CT T A 20-years-old male patient admitted to our hospital with nausea and vomitting after high dose paracetamol intake. With laboratory analysis and physical examination findings patient was diagnosed subacute fulminant liver failure. Urgent liver transplant was not considered according to King's College criteria and medical treatment was started. At follow up the patient's laboratory values and encephalopathy improved progressively but polyuria developed by day 7 of treatment (11 L/day). His serum sodium level increased to 152 mmol/L. His measured plasma osmolalite was 352 mOsmol/L, urine osmolalities were 171 mOsmol/L, the urinary specific gravity was 1003. The patient was diagnosed as CDI. After 10 mcg desmopressin therapy, urinary output fell under 3L/ day and patient discharged. As in our case, in liver failure patients CDI must be considered in cases that show polyuria.