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Posted On : 11 Jun 2014

A 11.5-year-old boy was admitted on January 4th beacause of hypernatremia {177 mmol, L}, hypertension {150, 90 mm Hg} and headache.
Personal history is remarkable for congenital hydrocephalus, and traumatic head injury at 5 years of age.
His last admission at neursorgery was in December 2009 when he hed revision of VP shunt and hypernatremia was 170, but with treatment it normalized.
At admission in our hospital his creatinine was 120 mcmol, L, serum osmolality 320, urine osmolality 605, Na 177 and he was dehydrated, with pulse rate of 120.
Initially he was on IV fluids, but after 2 days he was switched to oral fluids, forced to drink, his creatinine came down to 92 {upper range 80}, Na 155. His diuresis is around 3 l, but he drinks 5 l of water. His ADH is adequately elevated {0.11ng, ml for serum osmolality of 337}. His thyroid function tests are normal, basal cortisol was in lower range {taken after food}, synacthen test is pending, as well as aldosteron and PRA.
He does not have a sense of thirst, he is polyphagic and sweating is one of the complaints.
We would appreciate to hear your comments.
Thanks
Vera Zdravkovic
pediatric endocrinologist

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Answer 1

It may be Adipsic hypernatremia secondary to decreased thirst. However central DI should be ruled out though ADH is not bad. See whether there is therapeutic response to vasopressin.

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