Abstract: PUB261
A Matter of Fluid: Managing a Rare Case of Diabetes Insipidus and Multiple Sclerosis-Driven Hypernatremia
Session Information
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Yip, Henry, Stony Brook University Hospital, Stony Brook, New York, United States
- Kim, Claire, Stony Brook University Hospital, Stony Brook, New York, United States
- Andrade, Katherine, Stony Brook University Hospital, Stony Brook, New York, United States
- Abdulrahman, Rula A., Stony Brook University Hospital, Stony Brook, New York, United States
Introduction
Transient central diabetes insipidus (CDI) is a rare condition which may result in hypernatremia and is rarely associated with multiple sclerosis (MS). Here we report a case of new onset hypernatremia, likely secondary to CDI in a patient with MS after exhibiting mental status changes.
Case Description
A 55-year-old female with MS and neurogenic bladder with suprapubic catheter was admitted for urosepsis. On initial labs, she had an acute kidney injury (AKI), bland urinalysis with concentrated urine and she produced normal range urine output (UOP). Following AKI resolution, she developed stroke like symptoms followed by polyuria up to 6L/24h resulting in hypernatremia of 167mmol/L and urine osmolarity 140mmol/L. Non-contrast stroke imaging showed no acute cerebral vascular accidents. She was started on intravenous fluid (IVF) repletion, which was unable to keep up with UOP, and was treated with intranasal desmopressin. Following desmopressin administration her urine output decreased to 1.2-1.8L/24h, which she reports to be closer to her baseline and her hypernatremia was ultimately resolved with continued IVF.
Discussion
CDI is a polyuric, hypotonic state typically due to injury to the hypothalamic track and inability to release vasopressin. MS produces demyelinated plaques which have a broad range of symptoms, and rarely has been seen to cause CDI. Although multiple cases describe transient CDI following cerebral vascular accidents, trauma and acute MS flairs there is limited data regarding overall incidence or mechanism of this injury. This makes management of hypernatremia difficult as in addition to supportive management with fluid repletion, the underlying cause must also be addressed. In our case we believed her hypernatremia was driven by transient CDI and her MS as noted with her mental status change and negative stroke work up. Given the relative lack of data, she was started on IVF, and empirically treated with desmopressin. Managing both hypernatremia, and new onset CDI in MS, this unique patient presented a unique challenge and highlights a relatively under explored topic. To date, there are only a few prior cases reporting CDI presenting in a patient with MS, and our report aims to highlight the association and areas of future research.