Endocrine Abstracts

There is growing recognition within Endocrinology physician and patient groups of morbidity and mortality in association with prescribing errors and dysnatraemia, in hospitalised patients with cranial diabetes insipidus (CDI). The study had two aims; firstly, to assess outcomes in hospitalised patients (paediatric and adult) with CDI by review of electronic records from 2012-2021, and secondly, to assess the same patient cohort’s perceptions of their care via telephone questionnaire administered to patient or their parents. Eleven patients aged <18 years were included in the study (7 male), median age 13 (6-16) years. Median duration of CDI was 7 (1-12) years. Aetiology of CDI included hypothalamic-pituitary tumours (6), infiltrative disorders (2), and congenital (3). Route of desmopressin was oral in 9/11 patients. There were 21 admissions (33% emergency) to OUH in 7 patients, median length of stay 5 (1-16) days. Daily measurement of serum sodium was performed in 29% of admissions; hyponatraemia and hypernatraemia were noted in 33% and 29% of admissions respectively. Both hyponatraemia and hypernatraemia were noted in 19% of admissions. There were no cases of omission of desmopressin from the hospital drug-chart. Care was supervised by Endocrinology, or Endocrine consultation was sought in 84% of admissions post-2015. Five patients or their parents (45%) completed the questionnaire. Three patients (60%) self-reported one or more hospital admission since the diagnosis of CDI. One patient felt their medical team did not have a good understanding of the management of CDI during hospital admission, reporting confusion between CDI and diabetes mellitus in the hospital environment, leading to unnecessary blood glucose monitoring. No patient reported delay in administration of desmopressin in hospital although some reported frustration at a night-time dose of the drug being administered too early in the evening. Dysnatraemia is common in hospitalised paediatric patients with CDI. The majority of patients perceived that their medical team had a good understanding of CDI; this may be related to a high rate of Endocrine involvement compared with adult counterparts. A coordinated approach, including education of non-specialist hospital staff and early involvement by specialists, is needed to improve patient outcomes.