Neurogenic diabetes insipidus presenting in a patient with subacute liver failure: a case report

Shankar-Hari, Manu; Parsons, Anthony K; Burroughs, A K; Shaw, Steve; Agarwal, Banwari

doi:10.1186/1752-1947-4-232

Cited by 2 publications

(2 citation statements)

References 7 publications

(9 reference statements)

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“…Cerebral edema in particular has been associated with CDI in a number of clinical situations. Previous reports have described CDI as a consequence of cerebral edema following successful cardiopulmonary resuscitation [13], severe brain injury [14], and subacute liver failure [15]. While the exact etiology of CDI in cerebral edema is unclear, it has been theorized that injury or damage to the hypothalamus, pituitary stalk, or axon terminals in the posterior pituitary from inflammation and edema may be pathogenic mechanisms [16].…”

Section: Discussionmentioning

confidence: 99%

Central diabetes insipidus as a manifestation of cerebral edema in a patient with SARS-CoV-2 infection

Nilesh¹,

Zachary²

2021

Int J Case Rep Images

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SARS-COV-2, the virus responsible for coronavirus disease 2019 , has been associated with various clinical manifestations ranging from an asymptomatic carrier state to pneumonia and respiratory failure, encephalopathy, thromboembolic events, and death. The objective of this case report is to highlight an additional complication possible with COVID-19: central diabetes insipidus (CDI) in the setting of fulminant cerebral edema. A 66-year-old male presented with cough, shortness of breath, and fever and was found to have COVID-19 pneumonia. During the hospitalization, he developed acute hypernatremia with a significant increase in urine output associated with low urine osmolarity. Central diabetes insipidus was confirmed by administration of desmopressin. The presence of CDI along with worsening neurologic changes prompted cerebral imaging revealing intraparenchymal hemorrhages and significant edema. To our knowledge, this is the first report of CDI caused by cerebral edema in a patient with COVID-19. We present this rare association to help alert clinicians to the possibility of polyuria and CDI as a sign of potentially fatal neurologic sequelae of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Central diabetes insipidus as a manifestation of cerebral edema in a patient with SARS-CoV-2 infection

Nilesh¹,

Zachary²

2021

Int J Case Rep Images

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“…In literature only one case is present about CDI due to liver failure but there is not any case about CDI in paracetamol induced liver failure. 5 In our case our patient has taken a high dose of paracetamol. We can predict that this high dose may provoke CDI.…”

Section: Discussionmentioning

confidence: 99%

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

Kaplan¹,

Öztaş²,

Yüksel³

et al. 2017

World Clin J Med Sci

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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.

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Neurogenic diabetes insipidus presenting in a patient with subacute liver failure: a case report

Cited by 2 publications

References 7 publications

Central diabetes insipidus as a manifestation of cerebral edema in a patient with SARS-CoV-2 infection

Central diabetes insipidus as a manifestation of cerebral edema in a patient with SARS-CoV-2 infection

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

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