Endocrine Abstracts

Cranial Diabetes Insipidus (CDI) is associated with significant polyuria and is treated with desmopressin. Inappropriate or missed treatment can result in significant electrolyte imbalance and potential harm. A recent UK survey of Endocrinologists reported 55% had concerns about knowledge in their trust, 39% felt they had observed patients come to harm. Patients not receiving desmopressin have been associated with death, leading to an NHS England (NHSE) safety alert in 2016. We audited inpatients with CDI in 4 South West hospitals investigating desmopressin prescribing, administration, intravenous fluid monitoring before and after the NHSE safety alert (Jan 2015–16 and March 2016–17) and the impact on readmission. Thirty-two hospital admissions (26 patients) were studied (mean age 47 years, mean duration of CDI 9.6 years, 62% female). One additional patient with CDI, who had 32 unrelated individual admissions, was excluded as significantly skewed the results (but data will be shown). 50% had pan-hypopituitarism and were on hydrocortisone. Admissions were 84% emergency and 16% planned with range of sodium 112–153 mmol/l. 50% received the correct desmopressin dose (remainder mostly had inadequate documentation to determine the reason for not giving). 19% were hyponatraemic on admission, half of whom received their desmopressin. 25% had adequate fluid balance charts (40% received intravenous fluids). Three patients were readmitted within 30 days (unrelated to CDI). 20% had a documented endocrinology review within 24 hours of admission. There were no differences pre and post NHSE alert or clear differences amongst hospitals. NHSE safety alert has not improved management of patients with CDI which remains suboptimal. Healthcare professionals have limited understanding of CDI and therefore risk inappropriate management and referral to endocrinology is prudent. A patient information sheet to guide management as inpatients is now available locally. Recent publication of SFE clinical guidance should help to raise awareness and further improve care.