A clinical case of transient diabetes insipidus with high spinal trauma

Abstract

BACKGROUND: Diabetes insipidus is characterized by the kidneys’ inability to absorb water and concentrate urine, which is based on a defect in the synthesis or secretion of vasopressin and is manifested by severe thirst and excretion of large volumes of diluted urine. Data on diabetes insipidus in adults with isolated spinal injury are presented in single works of foreign authors, and no domestic and foreign publications have focused on diabetes insipidus in children. Available publications are descriptions and evaluations of the disease’s clinical picture according to clinical and laboratory abnormalities and analyzed therapy in the postoperative period.

CLINICAL CASE: This study presents a clinical case of transient diabetes insipidus in a 12-year-old patient with high-level spinal cord injury after shrapnel and explosive trauma. A detailed description of the clinical picture is provided.

DISCUSSION: Polyuria, polydipsia, and low urine density were noted on day 14 after surgical correction and stabilization of post-traumatic spinal deformity with spinal cord rupture at the C_VI–C_VII level. The condition was considered a transient diabetes insipidus. Clinical and laboratory recovery was achieved on day 12 after surgery thanks to treatment by desmopressin.

CONCLUSIONS: This clinical case presents that diabetes insipidus may develop in pediatric patients with isolated spinal injury. Given the insufficient understanding of the causes of this rare disease, differential diagnosis is necessary for pediatric patients with high-level spinal cord injuries associated with polyuria and low urine density. Moreover, treatment with desmopressin should be prescribed appropriately.

Keywords

diabetes insipidus / high-level spinal cord injury / pediatric spinal cord trauma / complication of spinal trauma / vasopressin deficiency / case report

References

[1] Dedov II, Mel’nichenko GA, Pigarova EA, et al. Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults. Obesity and metabolism. 2018;15(2):56–71. (In Russ.). DOI: 10.14341/omet9670

[2] Дедов И.И., Мельниченко Г.А., Пигарова Е.А., и др. Федеральные клинические рекомендации по диагностике и лечению несахарного диабета у взрослых // Ожирение и метаболизм. 2018. Vol. 15. No. 2. P. 56–71. DOI: 10.14341/OMET9670

[3] Dedov II, Mel’nichenko GA, Pigarova EA, et al. Federal clinical guidelines on diagnosis and treatment of diabetes insipidus in adults. Obesity and metabolism. 2018;15(2):56–71. (In Russ.). DOI: 10.14341/omet9670

[4] Gumbel JH. Investigations of potential mechanisms underlying spinal cord injury-induced polyuria [abstract dissertation]. 2021. [cited 2023 Feb 24]. Avaible from: https://ir.library.louisville.edu/etd/3739/

[5] Gumbel J.H. Investigations of potential mechanisms underlying spinal cord injury-induced polyuria: abstract dissertation. 2021. [дата обращения 24.02.2023]. Доступ по ссылке: https://ir.library.louisville.edu/etd/3739/

[6] Gumbel JH. Investigations of potential mechanisms underlying spinal cord injury-induced polyuria [abstract dissertation]. 2021. [cited 2023 Feb 24]. Avaible from: https://ir.library.louisville.edu/etd/3739/

[7] Gumbel JH, Yang CB, Hubscher ChH. Timeline of changes in biomarkers associated with spinal cord injury–induced polyuria. Neurotrauma Rep. 2021;2(1):462–475. DOI: 10.1089/neur.2021.0046

[8] Gumbel J.H., Yang C.B., Hubscher Ch.H. Timeline of changes in biomarkers associated with spinal cord injury–induced polyuria // Neurotrauma Rep. 2021. Vol. 2. No. 1. P. 462–475. DOI: 10.1089/neur.2021.0046

[9] Gumbel JH, Yang CB, Hubscher ChH. Timeline of changes in biomarkers associated with spinal cord injury–induced polyuria. Neurotrauma Rep. 2021;2(1):462–475. DOI: 10.1089/neur.2021.0046

[10] Dabrowski E, Kadakia R, Zimmerman D. Diabetes insipidus in infants and children. Best Pract Res Clin Endocrinol Metab. 2016;30(2):317–328. DOI: 10.1016/j.beem.2016.02.006

[11] Dabrowski E., Kadakia R., Zimmerman D. Diabetes insipidus in infants and children // Best Pract. Res. Clin. Endocrinol. Metab. 2016. Vol. 30. No. 2. P. 317–328. DOI: 10.1016/j.beem.2016.02.006

[12] Dabrowski E, Kadakia R, Zimmerman D. Diabetes insipidus in infants and children. Best Pract Res Clin Endocrinol Metab. 2016;30(2):317–328. DOI: 10.1016/j.beem.2016.02.006

[13] Kuzeyli K, Cakir E, Baykal S, et al. Diabetes insipidus secondary to penetrating spinal cord trauma: case report and literature review. Spine. 2001;26(21):E510–E511. DOI: 10.1097/00007632-200111010-00023

[14] Kuzeyli K., Cakir E., Baykal S., et al. Diabetes insipidus secondary to penetrating spinal cord trauma: case report and literature review // Spine. 2001. Vol. 26. No. 21. P. E510–E511. DOI: 10.1097/00007632-200111010-00023

[15] Kuzeyli K, Cakir E, Baykal S, et al. Diabetes insipidus secondary to penetrating spinal cord trauma: case report and literature review. Spine. 2001;26(21):E510–E511. DOI: 10.1097/00007632-200111010-00023

[16] Lieh-Lai MW, Stanitski DF, Sarnaik AP, et al. Syndrome of inappropriate antidiuretic hormone secretion in children following spinal fusion. Crit Care Med. 1999;27(3):622–627. DOI: 10.1097/00003246-199903000-00046

[17] Lieh-Lai M.W., Stanitski D.F., Sarnaik A.P., et al. Syndrome of inappropriate antidiuretic hormone secretion in children following spinal fusion // Crit. Care Med. 1999. Vol. 27, No. 3. P. 622–627. DOI: 10.1097/00003246-199903000-00046

[18] Lieh-Lai MW, Stanitski DF, Sarnaik AP, et al. Syndrome of inappropriate antidiuretic hormone secretion in children following spinal fusion. Crit Care Med. 1999;27(3):622–627. DOI: 10.1097/00003246-199903000-00046

[19] Iob I, Salar G, Mattisi G, et al. Diencephalic syndrome following cervical spinal cord trauma. Acta Neurochir (Wien). 1989;97(3–4):123–127. DOI: 10.1007/BF01772822

[20] Iob I., Salar G., Mattisi G., et al. Diencephalic syndrome following cervical spinal cord trauma // Acta Neurochir. (Wien). 1989. Vol. 97. No. 3–4. P. 123–127. DOI: 10.1007/BF01772822

[21] Iob I, Salar G, Mattisi G, et al. Diencephalic syndrome following cervical spinal cord trauma. Acta Neurochir (Wien). 1989;97(3–4):123–127. DOI: 10.1007/BF01772822

[22] Rosenbaum BP, Steinmetz MP. Central diabetes insipidus after staged spinal surgery. Global Spine J. 2013;3(4):257–260. DOI: 10.1055/s-0033-1345038

[23] Rosenbaum B.P., Steinmetz M.P. Central diabetes insipidus after staged spinal surgery // Global Spine J. 2013. Vol. 3. No. 4. P. 257–260. DOI: 10.1055/s-0033-1345038

[24] Rosenbaum BP, Steinmetz MP. Central diabetes insipidus after staged spinal surgery. Global Spine J. 2013;3(4):257–260. DOI: 10.1055/s-0033-1345038

[25] Machiedo G, Bolanowski PJ, Bauer J, et al. Diabetes insipidus secondary to penetrating thoracic trauma. Ann Surg. 1975;181(1):31–34. DOI: 10.1097/00000658-197501000-00008

[26] Machiedo G., Bolanowski P.J., Bauer J., et al. Diabetes insipidus secondary to penetrating thoracic trauma // Ann. Surg. 1975. Vol. 181. No. 1. P. 31–34. DOI: 10.1097/00000658-197501000-00008

[27] Machiedo G, Bolanowski PJ, Bauer J, et al. Diabetes insipidus secondary to penetrating thoracic trauma. Ann Surg. 1975;181(1):31–34. DOI: 10.1097/00000658-197501000-00008

[28] Kong Kam Wa T, McCarthy KF. Intra-operative diabetes insipidus associated with cervical spine traction during staged scoliosis surgery. Anaesth Rep. 2020;8(2):123–126. DOI: 10.1002/anr3.12068

[29] Kong Kam Wa T., McCarthy K.F. Intra-operative diabetes insipidus associated with cervical spine traction during staged scoliosis surgery // Anaesth. Rep. 2020. Vol. 8. No. 2. P. 123–126. DOI: 10.1002/anr3.12068

[30] Kong Kam Wa T, McCarthy KF. Intra-operative diabetes insipidus associated with cervical spine traction during staged scoliosis surgery. Anaesth Rep. 2020;8(2):123–126. DOI: 10.1002/anr3.12068

[31] Daia C, Munteanu C, Andone I, et al. Polydipsia-polyuria syndrome associated with traumatic spinal cord injury. Signa Vitae. 2021;17(6):74–81 DOI: 10.22514/sv.2021.104

[32] Daia C., Munteanu C., Andone I., et al. Polydipsia-polyuria syndrome associated with traumatic spinal cord injury // Signa Vitae. 2021. Vol. 17. No. 6. P. 74–81. DOI: 10.22514/sv.2021.104

[33] Daia C, Munteanu C, Andone I, et al. Polydipsia-polyuria syndrome associated with traumatic spinal cord injury. Signa Vitae. 2021;17(6):74–81 DOI: 10.22514/sv.2021.104

[34] Oz B, Olmez N, Memis A, et al. Differential diagnosis of polyuria and polydipsia in a patient with spinal cord injury. Am J Phys Med Rehabil. 2005;84(10):817–820. DOI: 10.1097/01.phm.0000179515.25335.af

[35] Oz B., Olmez N., Memis A., et al. Differential diagnosis of polyuria and polydipsia in a patient with spinal cord injury // Am. J. Phys. Med. Rehabil. 2005. Vol. 84. No. 10. P. 817–820. DOI: 10.1097/01.phm.0000179515.25335.af

[36] Oz B, Olmez N, Memis A, et al. Differential diagnosis of polyuria and polydipsia in a patient with spinal cord injury. Am J Phys Med Rehabil. 2005;84(10):817–820. DOI: 10.1097/01.phm.0000179515.25335.af

[37] Soltakhanov EM, Omarova NKh, Arslanbekova Ach, et al. Diabetes insipidus: modern look to the problem. Ecological Medicine. 2019;2(2):57–68. DOI: 10.34662/2587-6988.2019.2.2.57-68

[38] Солтаханов Э.М., Омарова Н.Х., Арсланбекова А.Ч., и др. Несахарный диабет: современный взгляд на проблему // Экологическая медицина 2019. Т. 2. № 2. С. 57–68. DOI: 10.34662/2587-6988.2019.2.2.57-68

[39] Soltakhanov EM, Omarova NKh, Arslanbekova Ach, et al. Diabetes insipidus: modern look to the problem. Ecological Medicine. 2019;2(2):57–68. DOI: 10.34662/2587-6988.2019.2.2.57-68

[40] Carmichael J.D. Keck School of Medicine of the University of Southern California. MSD Handbook, Medical Review. March 2021.

[41] Carmichael J.D. Keck School of Medicine of the University of Southern California. Справочник MSD, Медицинский обзор. Март 2021.

[42] Carmichael J.D. Keck School of Medicine of the University of Southern California. MSD Handbook, Medical Review. March 2021.