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.
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