Diabetes insipidus
Reassure
- Longstanding history of drinking large amounts of sweet drinks (often from a baby bottle)
- Blood glucose normal
- Growth normal
- No associated symptoms or signs
- Puberty stage appropriate for age
- No other associated risk factors for a brain tumour
- Normal neurological examination
- Normal visual assessment
Action
Reassure
Advise offering only water from a cup to drink
Review / Refer
- Excessive drinking and passing increased amounts of urine, of recent onset
- Blood glucose normal
- Abnormal growth (weight gain/weight loss) and/or pubertal abnormality
- Any risk factors for a brain tumour
Action
Refer for urgent general paediatric assessment
Scan
- Excessive drinking and passing increased amounts of urine, of recent onset
- Abnormal neurological examination or visual assessment
- One or more additional symptoms/signs which may be caused by a brain tumour
Action
Scan
Diagnostic Pitfalls
- Failing to consider diabetes insipidus in children with excessive fluid intake and excessive urine production
Examination/assessment
- Determine duration of excessive drinking
- Ask about bedwetting/getting up at night to pass urine
- If never dry at night, are they passing more urine at night
- What and when do they drink and what do they drink from (a child with DI will drink any fluid from any container)
- Ask specifically about associated symptoms and risk factors:
- Personal or family history of a brain tumour
- Leukaemia
- Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
- Neurofibromatosis types 1 and 2
- Tuberous Sclerosis
- Li Fraumeni Syndrome
- Family history of colorectal polyposis
- Gorlins Syndrome
- Other familial genetic syndromes
- Neurological examination (include assessment of vision (including acuity), gait and coordination)
- Plot growth in all children and pubertal status if applicable
- Plot head circumference in children under two
- Measure capillary blood glucose using a blood glucose meter
Worrying features
- Symptoms of new onset of excessive fluid intake and the need to pass urine so frequently that it disturbs sleep