Endocrine Abstracts

Diabetes insipidus is mainly associated with dehydration as a complication, hyponatremia being very rare. We report the case of a 75 years old female, from Switzerland, who presented with nausea and vomit, diarrhea, asthenia and general sickness at the emergency room, where blood tests revealed hyperglycemia of 320 mg/dl and hyponatremia of 115 mmol/l, the patient knowing to have diabetes insipidus and diabetes mellitus type II, with insulin and desmopressin. Following emergency equilibration, we recommended monitoring water intake, urine excretion in the absence of desmopressin, with control of glycemic profile every 4 hours, for the next 24 h, and a MRI scan, in order to objectivate the diagnosis. Initial cooperation was present. The anamnesis revealed diabetes insipidus diagnosed at age 30, treated with desmopressin spray 10 mcg two times a day, in the morning, and diabetes mellitus type II from age 60, treated with 4 shots of fast insulin, 42 U/day. Clinical examination revealed signs of mild dehydration. Lab tests highlighted mild hyperglycemia of 142 mg/dl and hyponatremia of 129 mol/l. Glycated haemoglobin was 7.3%. Plasmatic osmolarity was 272.3 mOsm. The patient was uncooperative to stoping or changing the schedule of desmopressin treatment, so she was discharged with natremia of 139 mmol/l. Recent medical history showed a recent emergency admission with similar clinical and biochemical futures. Moreover, it was proved that the patient had many ER admissions in Bucharest’s hospitals, with same situation. In this respect, the diagnosis of diabetes insipidus itself can be put under question, complicated by the psihogenic adherence to desmopressin treatment of the patient. Frequent clinical manifestations of hyponatremia due tu desmopressin abuse in our patient is highlighting not only the complexity of psihogenic association to organic abuse, but also the need for cooperation between practitioners across EU.