A patient with diabetes insipidus (DI) who has impaired thirst can be a challenge to manage. Such a patient may not know when or when not to drink water.
If the patient does not drink fluids, then s/he is at risk for dehydration and hypernatremia, especially during times of increased fluid loss.
If the patient receives too much fluid, then s/he may develop water intoxication and hyponatremia, especially if the dose of vasopressin is increased.
Goal
Therapy
restoring thirst
chlorpropamide
maintain adequate fluids
drink a predetermined amount of fluids every few hours according to a regular schedule
control fluid loss
regular dose of vasopressin or desmopressin
adjust fluid intake
regularly monitor serum sodium
confirm adherence to regimen
record and monitor fluid intake and output
control the DI
identify cause and treat if possible
Since the patient does feel thirst there may be reluctance to drink fluids over a long period of time.
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