Document Type
Presentation
Publication Date
4-13-2023
Abstract
Background
Several case reports show a rare association with the development of central diabetes insipidus and Acute Myeloid Leukemia as well as Central Diabetes Insipidus alternating with Cerebral Salt Wasting Syndrome in the adult population. We report a case where an individual found to have AML who later developed Central Diabetes Insipidus and then alternating Cerebral Salt Wasting Syndrome in a pediatric patient.
Clinical Case
A previously healthy 6 month old female infant, presented with new persistent fever and fatigue for three weeks. She was admitted found to have macrocytic anemia (8.4 g/dL), leukocytosis 29.2 x10E3/uL with 23.9 x10E3/uL lymphoblasts, and hypernatremia (149 mmol/L). Further workup including a blood smear showed an increase in blasts associated with a megakaryoblastic differentiation. On day two of admission, she developed polyuria, hypernatremia 156 mmol/L, and an increase in serum osmolality to 318, which are characteristic of the development of Central Diabetes Insipidus (DI). She started vasopressin which improved her serum sodium and urine output. A taper of vasopressin began and her serum sodium increased, so Vasopressin was restarted. Later, her serum sodium and urine output decreased, so restarted the vasopressin taper. In the next 48 hours, she developed hyponatremia to 120 mmol/L and hypokalemia to 2.1 mmol/L and had a urine output of 14.7 cc/kg/hr , which are characteristics of Cerebral Salt Wasting syndrome (CSW). The child fluctuated between DI and CSW over two weeks where she required Vasopressin therapy while in DI and Na and urine output replacement while in CSW. Bone marrow aspiration showed Non-Down Syndrome-associated pediatric megakaryoblastic acute myeloid leukemia. After stabilization with subcutaneous desmopressin, she began rasburicase and initial chemotherapy. Her central DI is managed through subcutaneous DDAVP injections.
Conclusion
The sooner Central diabetes Insipidus and Cerebral Salt Wasting are identified as possible differential diagnoses, the sooner treatment can begin as both pathologies require different treatment plans.
Recommended Citation
Sky, Kyree and Senan Hadid. "Central Diabetes Insipidus combined with Cerebral Salt Wasting Syndrome in the setting of Acute Myeloid Leukemia in a pediatric patient." (2023). https://digitalrepository.unm.edu/hsc_2023_pediatric_research/16
Published case report
Comments
Presentation presented at Pediatric Research Forum
This presentation is from the author's published work:
Sky K, Hadid S (2023) Central Diabetes Insipidus Alternating with Cerebral Salt Wasting Syndrome in an Infant with an Acute Myeloid Leukemia. Endocrinol Metab Syndr. 12:372.