Vasopressin for DI

[Shishkabob]

So I had a thought in class today and spoke to my teacher about it. He said he liked how I was thinking outside of the box, but he hasn't heard of any ambulance companies doing this for the main fact that it wouldn't have immediate effects that we'd see in the field so it would be more of a long term thing. I also googled it but everything was all over the place.



As we know, the main kind of diabetes insipidus is caused in part by the total lack of anti-diuretic hormone, which leads to dehydration.



Say you get a call to a person with diabetes insipidus and are dehydrated. Couldn't you give a small amount of vasopressin along with the normal fluids? Basically using the vasopressin for it's normal physiological use and not for it's vasoconstriction.



(PS-- I know the other type of DI is refractory to ADH, so vasopressin would be useless there).




Or am I missing something, which would explain why places around here don't do it?

 

[daedalus]

Are you freaking serious! You are totally missing the big picture here linus


JK!

I have nooo idea.

 

[Shishkabob]

I felt like an idiot until I read the rest of your post ^_^


I seriously thought I had missed something blatantly obvious that another medic student got asap... which very well might still be the case.

 

[Akulahawk]

If you can differentiate between the two types of DI... and you know that the patient is not producing vasopressin (ADH) vs being refractory to it, that might start the patient towards getting things under control. I suspect that you might need to be able to test for presence and amount of ADH in the blood first and be able to deliver the proper physiologic amount, or to bring the body to a proper physiologic level...

It's certainly thinking out of the box...

 

[daedalus]

I felt like an idiot until I read the rest of your post ^_^


I seriously thought I had missed something blatantly obvious that another medic student got asap... which very well might still be the case.

Well count me on your side of the fence of missing something really obvious than, because it sounds good in theory to me too

 

[Shishkabob]

Yea, my idea would have only been for people we knew had DI with no ADH making... but I also know how much we hate pushing drugs blind.

 

[Crepitus]

Well there are oral meds for DI (desmopressin is one) are along that line so it's a great question.

 

[So. IL Medic]

Neat question. Yes, central DI is a result of hypothalmic or pituitary failure to release ADH and yes, vasopressin would help prevent the constant excretion of water in the long term. A single dose would have little effect.

However, I found an article - Vasopressin and Diabetes mellitus
Lise Bankira, Pascale Bardouxa, Mina Ahloulayb, Nephron 2001;87:8-18 - that stated "A high VP level is beneficial in the short term because it limits to some extent the amount of water required for the excretion of a markedly enhanced load of osmoles (mainly glucose). However, in the long run, it may have adverse effects by favoring the developement of diabetic nephropathy."

So as VP would have little effect in the field and potential long term effects as a prolonged treatment, I can't see any value of us using it.