Ultralow doses of vasopressin in the management of diabetes insipidus.

Management of postoperative diabetes insipidus (DI) frequently requires intermittent treatment with multiple subcutaneous injections of pituitrin or vasopressin, in doses averaging 20 IU/24 h. Use of a syringe pump for a continuous infusion of ultralow doses of pituitrin produced uniform, constant, and sustained reduction of urinary output, thus facilitating regular fluid replacement. Twelve patients with postoperative DI received iv pituitrin at a dose of 1.6 +/- 0.26 mIU/kg X h (1 to 2 IU/24 h). The antidiuretic effect began at the third hour of treatment, peaked by the sixth hour (diuresis of 37 ml/h, specific gravity of 1.018 +/- 0.002), and was sustained throughout infusion. Polyuria recurred 3 h after the infusion was discontinued; this rapid reversibility is highly advantageous when excessive fluid intake causes overhydration. Pressor effects were not observed during the treatment period.

[Anuria caused by tight stenosis of the renal arteries. 2 cases]. / Anurie par sténose serrée des artères rénales. Deux observations.

Two patients developed anuria associated with tight stenosis, though not complete obstruction, of the renal arteries. This rare and little known accident is found in atheromatous patients with severe arterial hypertension of renovascular origin. It usually occurs when blood pressure falls under the influence of a precipitating factor. Diagnosis rests on angiography. Diuresis is resumed immediately after surgical revascularization. The operation must be performed in every case, even after a long delay, since the kidneys remain viable for a long time due to the development of an extensive collateral circulation. Such anurias are particularly severe in patients with poor underlying condition and when vascular lesions are diffuse.