Hello Marsha, 
I feel compelled to answer this as I recently became more familiar than
I ever wanted to be with Diabetes Insipidous through my own daughter's
condition.  

Your patient most likely has developed the gestational form of DI,
however, I can't stress enough that she should be screened for a
Pituitary Adenonma also.  These tumors are easy to miss, as the symptoms
are so often subtle until they manifest as a severe symptom, such as
Diabetes Insipidous, so it should never be assumed that the DI is only
gestationally induced.  

According to Dr Hale's rankings, the DDAVP is an L2 and safe enough. I
would have her be very careful with dehydration risk.  This lady should
never, ever, be without water!  No matter where a DI patient is they
should never be without water to drink and for a nursing mom, she could
dehydrate in 15 minutes or less.  So she should have at least 3 liters
with her or readily available at all times.  Naturally, to maintain
supply she should constantly be sipping water when awake.  There is a
good reason this is known as the endless water disease.  

For best information on DI, I prefer the DI association web site
www.diabetesinsipidus.org

For information on Pituitary Adenomas I like best the Mayo Clinic site
http://www.mayoclinic.com/health/pituitary-tumors/DS00533/DSECTION=sympt
oms

This should give you a start and if I can help in any way, let me know.

Sincerely,
Margaret 

Margaret E. Pearce (Meg) RN IBCLC
Lactation Service
Rogue Valley Medical Center, Asante Health System
2825 East Barnett Road
Medford, Oregon 97504
Office:  (541) 789-5984
Fax:  (541) 789-5935
Email: [log in to unmask]


Date:    Tue, 29 Dec 2009 10:01:56 -0500
From:    [log in to unmask]
Subject: Diabetes insipidus

I received a call from a physician of a mother as well as the mother
herself who has been diagnosed with diabetes insipidus. I know that
prolactin secretion is affected by a number of hormones including
oxytocin and vasopressin (the antidiuretic hormone). Diabetes insipidus
results from a deficiency in the secretion of vasopressin from the
posterior pituitary or the inability of the kidney to respond to the
hormone. The mother talked of excessive urine output and I am wondering
if this large disturbance in water and electrolyte regulation is going
to adversely impact sucking-induced prolactin release and ultimately
this mother's milk production. What should we be recommending in the way
of breastfeeding management guidelines. Are there medications that this
mother will be placed on that are of concern? I have not seen this
condition for awhile and am looking for current treatment guidelines and
any of your collective experiences with this.

Marsha Walker, RN, IBCLC
Weston, MA





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