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Water restriction
36%
31/87
Loop diuretic
2%
2/87
CT scan of the brain
0.45% NaCl administered intravenously
6%
5/87
Desmopressin
52%
45/87
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The patient’s history and lab results are consistent with post-surgical central diabetes insipidus. The most reasonable next step is administration of desmopressin or chlorpropamide. Diabetes insipidus (DI) can be classified as central or nephrogenic. Central DI is caused by a deficiency in antidiuretic hormone (ADH) secretion, while nephrogenic DI is caused by resistance to ADH. In this situation, the patient has recently undergone transphenoidal resection of a pituitary adenoma and central DI is a known complication. Symptoms of central DI include polyuria, nocturia, and polydipsia. Lab work typically shows elevated serum sodium, low urine osmolality (50-200 mOsm/kg), and elevated serum osmolality. First line treatment for central DI is administration of desmopression, an ADH analog. Alternatively, chlorpropamide, carbamazepine, and thiazide diuretics have also been used to treat central DI. Incorrect Answers: Answer 1: Water restriction can be used to distinguish central DI from primary polydipsia - however, in this situation, the clinical picture points toward central DI. Answer 2: Loop diuretics are not used in the treatment of DI. Answer 3: CT scan of the brain would likely reveal post-operative changes, but not help diagnose DI. Answer 4: Administration of fluids would not be sufficient for treatment of DI.
3.3
(8)
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