Treatment of diabetes insipidus with DDAVP.

The treatment of a patient with diabetes insipidus (DI) is described, and the general treatment of the syndrome is reviewed. The patient was a 16-year-old male who had experienced pain, inflammation and tenderness in the left gluteal region owing to an abcess at the site of intramuscular injection of vasopressin tannate in oil (VTO). (He had been diagnosed as having DI at age 8. Since then, he had been maintained on VTO, lypressin and posterior pituitary snuff.) After the abscess healed during hospital treatment, VTO was stopped and the patient's urinary output increased sharply; urine specific gravity and osmolarity decreased correspondingly. Three days after stopping VTO, the investigational drug, 1-deamino-8-D-arginine vasopressin (DDAVP), was begun at 10 microgram every 12 hours. The dose was eventually increased to 20 microgram every 12 hours, and the patient was discharged on this regimen which controlled his urine output, specific gravity and osmolarity. Other treatments reviewed include antidiuretic-hormone-replacement agents (vasopressin, lypressin) and drugs used to potentiate low ADH levels (chlorpropamide, clofibrate and carbamazepine).

Quality control of small-volume sterile products.

A method for bacterial surveillance of small-volume sterile products in hospitals was developed and tested. The criteria for the method of quality control were to: (1) assure detection of contamination associated with touch, which could occur during the filling process; (2) be economically feasible; (3) be simple and easy to implement; and (4) be versatile in adapting to small-volume sterile packages with and without needles. Ten percent of each lot of prepackaged unit dose syringes is tested by filtration through a sterile micropore filter. The filter unit is incubated after fluid thioglycollate medium has been added. If turbidity or color change is found, further testing with blood agar and gram staining is performed to identify the organism. The effectiveness of the method was tested by adding E. coli to one lot within each of several lots tested of six products. The inoculated samples were stored under refrigeration for three days before testing. With one exception, the E. coli was detected in the samples. Growth did not occur in any of the noninoculated units. The apparent false negative result was believed to be caused by the bacteriostatic agent killing the organism during the three-day storage period.