Central diabetes insipidus: alert for dehydration in very low birth weight infants during the neonatal period. A case report / Diabete insípido central: alerta para desidratação no período neonatal em recém-nascidos de muito baixo peso. Um relato de caso

CONTEXT: Central diabetes insipidus (CDI) is a rare cause of hypernatremia during the neonatal period. The diagnosis is particularly difficult in very low birth weight (VLBW) newborns. CASE REPORT: We report on a preterm newborn who presented CDI soon after birth. On the third day of life, signs of dehydration were present despite normal fluid supply. The diuresis rate was 4.4 ml/kg/h. Although the fluid supply was then increased, the dehydration continued, with hypernatremia, normal glycemia, diuresis of 7.4 ml/kg/h and urine density of 1005 mOsmol/l. Thus, a diagnostic hypothesis of diabetes insipidus was raised. A test with a nasal vasopressin analogue (dDAVP) was performed and CDI was confirmed. Reduction of the fluid supply became possible through appropriate treatment. CONCLUSION: The diagnosis of CDI is rarely made during the neonatal period, especially in VLBW newborns, because of the difficulty in detecting elevated diuresis. Persistent hypernatremia, usually accompanied by hyperthermia despite abundant fluid supply, weight loss and low urine osmolality are important signs of alert. .

CONTEXTO: Diabete insípido central (DIC) é uma rara causa de hipernatremia durante o período neonatal. O diagnóstico é difícil, particularmente em recém-nascidos (RN) de muito baixo peso (RNMBP). RELATO DE CASO: Relatamos um RN que apresentou DIC logo após o nascimento. No terceiro dia de vida, apresentava sinais de desidratação, embora estivesse recebendo aporte adequado de líquidos. A diurese aferida era de 4,4 ml/kg/h. Apesar do aumento do aporte hídrico, manteve-se desidratado, com hipernatremia, valores normais de glicemia e diurese de 7,4 ml/kg/h com densidade urinária de 1005 mOsmol/l. Desta forma, a hipótese diagnóstica de diabete insípido foi considerada. O teste com análogo da vasopressina (dDAVP) foi realizado e DIC foi confirmado. A redução do aporte de líquidos foi possível com o tratamento adequado. CONCLUSÃO: O diagnóstico de DIC raramente é realizado durante o período neonatal, particularmente em RNMBP, devido à dificuldade em detectar diurese aumentada. Hipernatremia persistente, geralmente acompanhada de hipertermia, apesar do abundante aporte de água, perda de peso e osmolaridade urinaria baixa, são importantes sinais de alerta. .

Central diabetes insipidus: alert for dehydration in very low birth weight infants during the neonatal period. A case report.

CONTEXT: Central diabetes insipidus (CDI) is a rare cause of hypernatremia during the neonatal period. The diagnosis is particularly difficult in very low birth weight (VLBW) newborns. CASE REPORT: We report on a preterm newborn who presented CDI soon after birth. On the third day of life, signs of dehydration were present despite normal fluid supply. The diuresis rate was 4.4 ml/kg/h. Although the fluid supply was then increased, the dehydration continued, with hypernatremia, normal glycemia, diuresis of 7.4 ml/kg/h and urine density of 1005 mOsmol/l. Thus, a diagnostic hypothesis of diabetes insipidus was raised. A test with a nasal vasopressin analogue (dDAVP) was performed and CDI was confirmed. Reduction of the fluid supply became possible through appropriate treatment. CONCLUSION: The diagnosis of CDI is rarely made during the neonatal period, especially in VLBW newborns, because of the difficulty in detecting elevated diuresis. Persistent hypernatremia, usually accompanied by hyperthermia despite abundant fluid supply, weight loss and low urine osmolality are important signs of alert.

Eugenia punicifolia (Kunth) DC. as an adjuvant treatment for type-2 diabetes mellitus: a non-controlled, pilot study.

Type-2 diabetes mellitus (DM) is a highly prevalent disease with significant morbidity and mortality around the world. However, there is no universally effective treatment, because response to different treatment regimens can vary widely among patients. In this study, we aimed to investigate whether the use of the powdered dried leaves of Eugenia punicifolia (Kunth) DC. (Myrtaceae) is effective as an adjuvant to the treatment of patients with type-2 DM. Fifteen patients were enrolled in a pilot, non-controlled study, and received E. punicifolia for 3 months. After treatment, we observed a significant decrease in glycosylated hemoglobin, basal insulin, thyroid-stimulating hormone, C-reactive protein, and both systolic and diastolic blood pressure. There were no changes in fasting and postprandial glycemia. The compounds myricetin-3-O-rhamnoside, quercetin-3-O-galactoside, quercetin-3-O-xyloside, quercetin-3-O-rhamnoside, kaempferol-3-O-rhamnoside, phytol, gallic acid, and trans-caryophyllene present in the powdered dried leaves of E. punicifolia may be responsible for the therapeutic effect. In conclusion, the powdered leaves of E. punicifolia are promising as an adjuvant in the treatment of type-2 DM and deserve further investigation.