Endocrine Abstracts

Background: Cranial diabetes insipidus (DI) is characterised by the inability to produce ADH (antidiuretic hormone) also known as AVP (arginine vasopressin) resulting in uncontrolled diuresis. Desmopressin is a synthetic form of AVP used to treat this. Treatment errors can lead to dehydration and hypernatremia which can be life-threatening. In view of recent literature suggesting current concerns with Desmopressin administration worldwide, Diabetes Insipidus is currently undergoing a proposed name change to Arginine Vasopressin (AVP) deficiency.

Methodology: We audited the standards set in the "Society for Endocrinology clinical guidance: Inpatient management for cranial diabetes insipidus". We reviewed all admissions October 2020 - November 2022 where Desmopressin was prescribed with a diagnosis of AVP deficiency (DI).

Results: There were 35 admissions of patients with AVP deficiency (DI). An absence of a ‘DI/AVP deficiency’ alert on the patient electronic system was noted in 27 (77%) patients. An error in Desmopressin prescription was noted in 22 admissions (63%), with multiple errors in some admissions resulting in a total of 28 errors in total. In 4/35 of admissions the Desmopressin was omitted appropriately. The cause of Desmopressin delay in patients whom it was inappropriate to omit Desmopressin can be see in Table 1.

Conclusion: Our audit has shown the time from admission to administration of Desmopressin in patients in AVP deficiency is inadequate. A significant proportion of errors were due to drug unavailability and lack of timely prescription. Going forward, we hope to reduce Desmopressin administration delays by increased drug availability, use of patient safety electronic alerts, education and that increased healthcare professional awareness of this condition by the use of the new name AVP deficiency.