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Central diabetes insipidus misdiagnosed as acute gastroenteritis in a pediatric patient

Published online by Cambridge University Press:  21 May 2015

Laleh Gharahbaghian ,
Shahram Lotfipour ,
Christopher E. McCoy ,
Wirachin Hoonpongsimanont  and
Mark Langdorf
Laleh Gharahbaghian
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, Calif.
Shahram Lotfipour*
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, Calif.
Christopher E. McCoy
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, Calif.
Wirachin Hoonpongsimanont
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, Calif.
Mark Langdorf
Affiliation:
Department of Emergency Medicine, University of California, Irvine School of Medicine, Orange, Calif.
*
Department of Emergency Medicine, 101 The City Dr., Rte. 128-01, Orange CA 92868; [email protected]

Abstract

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This case report describes an unusual presentation of nausea, vomiting and diarrhea, which was misdiagnosed as acute gastroenteritis in a 6-year-old girl. The patient later returned to the emergency department (ED) with severe dehydration from idiopathic central diabetes insipidus (DI). At her first visit, this previously healthy patient presented with mild dehydration, signs of acute gastroenteritis and normal urine output. Her brother had experienced similar symptoms a few days earlier. She tolerated an oral fluid challenge and was discharged from the ED with stable vital signs. Two days later, the patient returned with severe dehydration, resolving diarrhea and persistent vomiting. She was admitted to the pediatric intensive care unit. Magnetic resonance imaging illustrated an absent posterior pituitary enhancing signal, which demonstrated a loss of function in that region. There were no other abnormalities. The patient subsequently received desmopressin with improving clinical status and was discharged on the eighth hospital day. DI is a rare disease, but can be fatal if left undiagnosed. It should, therefore, be considered in the differential diagnosis of a dehydrated patient with an unexpectedly low urine specific gravity.

Keywords

diabetes insipidusdehydrationpediatricgastroenteritis
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 5 , September 2008 , pp. 488 - 492
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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