Diabetes Insipidus in Children

Diabetes insipidus is a relatively rare disorder where the body does not create enough vasopressin or stops responding to this anti-diuretic hormone. Vasopressin helps the kidneys recognize and regulate the amount of water that is in the body. Manufactured by the hypothalamus and released by the pituitary gland, this hormone helps to keep children from becoming too dehydrated.

What Does It Mean to Have Diabetes Insipidus?

A child that has been diagnosed as having diabetes insipidus will show symptoms of having excessive thirst. They will also want to use the bathroom regularly throughout the day. There may be struggles to sleep through the night because of the urge to urinate or they may frequently wake up with wet bedsheets. These symptoms occur because of the changes in vasopressin production or recognition.

In children, there are two basic types of diabetes insipidus. The first, called central diabetes insipidus, occurs when there is a problem with the production mechanisms of the anti-diuretic hormone. Either the hypothalamus is not making enough of it or the pituitary gland is not releasing enough of it. As a result, the kidneys release fluids instead of concentrating wastes within them, causing very diluted urine to be created.

Central diabetes insipidus is often what affects children.

The second form of this disorder is called nephrogenic diabetes insipidus. This occurs when the kidneys fail to respond to an appropriate amount of vasopressin within the body. It may be genetic in nature, caused by an injury, or develop because of an unknown reason. In children, the nephrogenic version of this disorder to relatively rare.

There is a third form of diabetes insipidus that is called dipsogenic. This refers to the fact that there isn’t a physical condition that is causing the excessive thirst or intake of fluids. Although it may be possible to have damage to the hypothalamus in children to have this condition develop, it is so rare that there aren’t any statistics or treatment guidelines in place for children with this version of diabetes insipidus.

What Are the Dangers of Pediatric Diabetes Insipidus?

The issue with this disorder in children is that it may cause severe health problems as their bodies continue to develop and grow. Children may have delayed growth patterns and develop learning disabilities because of this disorder. Their skin may feel cool or clammy and they could struggle to put on weight, further adding to the difficulties of development.

Although these can be signs and symptoms of other illnesses or disorders, if they are matched up with excessive thirst and urination, then it is important to see a medical provider right away.

Are There Risk Factors for Diabetes Insipidus In Children?

If a child is diagnosed with nephrogenic diabetes insipidus, then there is a good chance that there is a genetic disorder has been present since birth. Boys are usually affected more often by this disorder than girls, but mothers can pass on the gene which causes diabetic insipidus to both boys and girls.

How To Plan For Your Diabetes Insipidus Appointment

If an appointment is scheduled for a child to see their medical provider about diabetes insipidus, then the provider may make specific requests of the parents that must be followed before the appointment. The most common request is to stop giving the child water to drink before going to bed the night before, but only do this if a medical provider specifically requests this.

It is also important to write down all symptoms that a child is experiencing. There are some other disorders and diseases that may cause symptoms that are similar to diabetes insipidus in children, so the symptom diary could be quite beneficial to a diagnosis.

Make sure any other important medical information is brought along for the appointment, even if it seems meaningless, so that a full overview of a child’s health can be examined during the appointment.

Tests Children Should Expect During Their Appointment

The most common test that is performed is a water deprivation test. This is why it is important to follow a medical provider’s instructions regarding water restriction. If urination continues at high levels even without water being consumed, then this can be a key indicator that a child is suffering from diabetes insipidus.

Doctors may also ask a child to give them a urine sample so that the composition of the urine can be examined. If the urine sample is highly diluted, even after water deprivation occurs, then this is another key sign that diabetes insipidus may be the cause of the problems being experienced.

An MRI may also be ordered if there is a suspected issue with the hypothalamus or pituitary gland. Some providers may choose to order a CT scan instead depending on the personal medical history of the child. This will give the provider a detailed image of the tissues and glands so that any abnormalities that could be causing the condition can be discovered.

If there is a family history of diabetes insipidus, then genetic screening may also be recommended for the child.

How Is Diabetes Insipidus in Children Treated?

The goal in treating diabetes insipidus in children is to help them deal with the dangers of dehydration while minimizing the effects of the disorder. This is because if left untreated, the child’s body will not have enough water left for it to be able to function properly. Dehydration may also cause headaches, fevers, low blood pressure, and muscle weakness. Children with diabetes insipidus who are dehydrated because of it tend to be rather lethargic despite wanting to drink fluids on a regular basis.

Managing the balance of electrolytes is also important for children with diabetes insipidus. Changes in sodium or potassium levels tend to be what is most commonly seen and this may cause children to not want to eat or become irritable.

Additional fluids and specific electrolytes may be given to manage this situation. If it is central diabetes insipidus that is the issue, then a medical provider will likely introduce a hormone therapy for the child. This involves introducing additional vasopressin or desmopressin, a synthetic alternative, into the child’s body. It can be taken as a tablet, but is most commonly recommended in a nasal spray form.

In the nephrogenic version of diabetes insipidus in children, the kidneys have stopped responding to the vasopressin. This means adding more hormone to the body isn’t going to provide any benefits. In this circumstance, a medical provider will likely recommend children begin following a low-salt nutritional plan. This will help to reduce the amount of urine that is created.

It will also be important for children to drink enough water every day. Certain children may respond to a diuretic drug called hydrochlorothiazide, which helps them to reduce the amount of urination which occurs.

Certain medications that a child may be taking for other conditions or disorders may also provide the foundation of diabetes insipidus to occur, as can certain surgeries that are performed to correct serious health issues. Stopping the medication or allowing the child to heal can help to resolve this disorder over time. Some medications must be stepped back slowly, so do not have a child stop taking any medications that have been prescribed unless under the advice and supervision of a doctor.

What Is the Prognosis of Diabetes Insipidus in Children?

For most children, the prognosis of a happy, fulfilling life is good if their diabetes insipidus is treated early. Since most children will have central diabetes insipidus, finding the appropriate desmopressin therapy can restore the child’s body to normal functioning rather quickly. Because vasopressin levels can vary from day to day, the dosage of desmopressin that is necessary for proper fluid retention will also vary daily. For this reason, the prescription if often written as a PRN [as needed] medication.

Early onset nephrogenic diabetes insipidus is particularly dangerous to children. Because there is a reduced ability to treat this disease, children that are unable to follow a low-salt diet plan and drink enough fluids may begin developing attention deficit disorders, become hyperactive, or experience delays in their motor development.

Even with nephrogenic diabetes insipidus, however, the outlook looks good as long as a child has access to the water their body needs at all times. Because excessive urination will create massive fluid losses, a child may need to have water with them at all times so they can replace those fluids immediately.

Diabetes insipidus in children can be dangerous if it is left untreated, but with treatment, children can continue to thrive and grow as they normally would without the disorder. If excessive thirst or unusual amounts of urination are observed in your children, then begin tracking their symptoms and make sure there is enough water available. If the condition doesn’t resolve itself in a couple of days, then contact your child’s medical provider for specific advice or to schedule an appointment to have the condition evaluated.