What are the recommended management strategies for a patient diagnosed with central diabetes insipidus?

The cornerstone of management for central diabetes insipidus is replacement therapy with desmopressin Lu 2017Garrahy et al. 2019Christ-Crain & Gaisl 2021. Desmopressin is a synthetic analogue of vasopressin, which effectively replaces the deficient antidiuretic hormone Lu 2017. This medication can be administered through various routes, including oral, intranasal, or parenteral, depending on the patient's clinical needs and preferences Garrahy et al. 2019. The primary objective of desmopressin therapy is to control symptoms such as excessive urination (polyuria) and extreme thirst (polydipsia), thereby preventing dehydration and dangerously high sodium levels (hypernatremia) Garrahy et al. 2019.

Careful monitoring of fluid balance and serum sodium levels is essential to prevent complications, especially hyponatremia, which can arise from overtreatment with desmopressin or excessive fluid intake NICE CKS Garrahy et al. 2019Christ-Crain & Gaisl 2021. Patients require comprehensive education on how to adjust their desmopressin dose based on their individual thirst and urine output Garrahy et al. 2019. It is also crucial to advise patients to avoid excessive fluid consumption, particularly when the desmopressin is actively working Garrahy et al. 2019. Regular follow-up appointments are necessary to fine-tune the desmopressin dosage, aiming for optimal symptom control while maintaining normal serum sodium levels Garrahy et al. 2019. In situations where patients are unable to manage their fluid intake independently, such as during acute illness or unconsciousness, fluid restriction may be implemented to prevent the development of hyponatremia Garrahy et al. 2019.