Society for Endocrinology - a world-leading authority on hormones

Arginine Vasopressin Deficiency (Diabetes Insipidus) information

Diabetes insipidus is a rare but treatable chronic condition caused by the lack of the posterior pituitary hormone vasopressin (AVP, also known as anti-diuretic hormone) resulting in uncontrolled diuresis. It is treated with desmopressin (DDAVP, a synthetic AVP analogue) which reduces diuresis.

Treating patients with diabetes insipidus

Diabetes insipidus is treated with demopressin/DDAVP in the following doses:

oral or sublingual - 100-200µg (0.1-0.2mg)
intranasal spray - 10=20µg
IM or IV injection - 1-2µg

Please note, in patients with decompensated diabetes insipidus fluid replacement should be the primary treatment with the aim of reducing hypernatraemia and 1-2ug IV or IM DDAVP administered with close attention paid to the clinical and biochemical response to prevent over-rapid overcorrection of hypernatraemia.

Management summary for inpatients with diabetes insipidus

Society for Endocrinology guidelines for the inpatient management of diabetes insipidus

For patients who can manage their condition themselves

Patients with diabetes insipidus who have a functioning thirst mechanism and are able to maintain their fluid intake through drinking should be identified on admission and allowed to continue their normal prescribed desmopressin/DDAVP. If they receive intravenous fluid therapy serum sodium levels should be monitored at least every 24 hours in case hyponatraemia occurs.

Download clinical guidelines for treating inpatients with diabetes insipidus

For patients who require help to manage their condition

Patients with diabetes insipidus who do not have a functioning thirst mechanism or are unable to maintain their fluid intake through drinking (due to disability, reduced consciousness or primary pathology) should be identified on admission and provided with the agreed, prescribed dose of desmopressin/DDAVP.

Fluid status should be assessed regularly, including monitoring of fluid input and urine output. Serum sodium should be measured at least every 12 hours until the patient can manage their own fluid intake or are clinically stable. Replacement fluids should be given orally or nasogastrically as quickly as is clinically safe to minimise the risk of rapid changes in serum sodium.

Download clinical guidelines for treating inpatients with diabetes insipidus

For patients who are seriously unwell

Patients with diabetes insipidus who are seriously unwell with inter-current illness or decompensated diabetes insipidus should be identified on admission and managed as a medical emergency with a level 2-3 care or equivalent high dependency setting.

Patients should be urgently clinically assessed for volume and hydration status, and measurements of serum sodium, potassium and renal function taken. Replacement fluids should be given orally or nasogastrically as quickly as is clinically safe to minimise the risk of rapid changes in serum sodium.

Serum sodium should be measured every 4 hours during fluid resuscitation. Fluid replacement should take priority over desmopressin/DDAVP administration with monitoring to ensure that over-rapid correction of hypernatraemia does not occur once desmopressin/DDAVP is given.

Download clinical guidelines for treating inpatients with diabetes insipidus

Additional information

Diabetes insipidus patient card

The Pituitary Foundation has produced a card for people with diabetes insipidus or vasopressin insufficiency to inform doctors of their condition and treatment requirements.

Download the patient card

Introduction to diabetes insipidus