Transient Diabetes Insipidus Following Thermal Burn; A Case Report and Literature Review

Central diabetes insipidus and burn trauma

Diabetes insipidus (DI) is characterized by polyuria and polydipsia. In most cases, the condition results from either an inadequate release or resistance to the activity of antidiuretic hormone in the renal collecting tubules. The underlying pathophysiology may be related to destruction the destruction or degeneration of neurons from inflammatory, autoimmune diseases, vascular diseases, Langerhans cell histiocytosis, sarcoidosis, or trauma. However, a large majority of diabetes insipidus cases (50%) are considered idiopathic. An exceedingly rare cause of idiopathic central DI occurs in burn injuries, which has only been reported in eight cases. We present an extremely rare case of idiopathic DI in a 15-year-old male with 76% total body surface area (TBSA) burns with the development of idiopathic central DI. An extensive literature review was accomplished to compare this case with the small number of previously reported case reports of idiopathic DI in burn patients.

Lay Summary

Diabetes insipidus (DI) is a rare complication of burn injuries that results from the destruction of neurons involved in the secretion of antidiuretic hormone from the pituitary gland. Only eight cases of DI have been reported in the literature in association to burn injuries. The patient in this case report received immediate fluid resuscitation, burn treatment, and intensive observation after the initial burn injury. The rapid response was likely the main reason for the absence of neurological damage as reported in the CT image. Therefore, the treatment of burn injuries remains an important step for reducing neurological damage and hormonal dysregulation leading to diabetes insipidus.

The Role of the Immune System in Pediatric Burns: A Systematic Review

Burns are one of the most common causes of home injuries, characterized by serious damage to the skin and causing the death of affected tissues. In this review, we intended to collect information on the pathophysiological effects of burns in pediatric patients, with particular emphasis on local and systemic responses. A total of 92 articles were included in the review, and the time range of the searched articles was from 2000 to 2021. The occurrence of thermal injuries is a problem that requires special attention in pediatric patients who are still developing. Their exposure to various burns may cause disturbances in the immune response, not only in the area of tissue damage itself but also by disrupting the systemic immune response. The aspect of immunological mechanisms in burns requires further research, and in particular, it is important to focus on younger patients as the existence of subtle differences in wound healing between adults and children may significantly influence the treatment of pediatric patients.

Probable Dexmedetomidine Induced Diabetes Insipidus: A Case Review

What is known and objective: Despite increased use of dexmedetomidine as a light sedative in the ICU setting, diabetes insipidus (DI) secondary to a dexmedetomidine infusion has rarely been reported. Case summary: We present a 32-year-old male admitted to the surgical intensive care unit (ICU) with 50% total body surface area burn. A short time following initiation (0.2 mcg/kg/hr) and up-titration (0.8 mcg/kg/hr) of dexmedetomidine continuous infusion, the patient developed DI, eventually exceeding 3 L of urine within a 6-hour timeframe. Excessive polyuria also led to significant electrolyte shifts (serum sodium 156 mmol/L and serum potassium < 1.8 mmol/L), resulting in Torsade's de Pointes. What is new and conclusion: Our case discusses diabetes insipidus leading to severe electrolyte abnormalities secondary to dexmedetomidine.