Paeds Cases · nephrology-urology-fluids-and-electrolytes
Hyponatraemia and hypernatraemia — OSCE
OSCE communication and clinical reasoning station for the family of a child with diabetes insipidus and hypernatraemia, covering the diagnosis, the role of desmopressin, the importance of free-water access, the safety-net for illness, and the slow-correction principle.
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You are the paediatric registrar. Your patient is 6 and has just had surgery for a brain tumour near his pituitary. The surgery has left him with central diabetes insipidus: his body no longer makes the hormone that tells the kidney to hold onto water, so he passes large volumes of dilute urine and drinks constantly to keep up. If he cannot drink enough, his sodium rises dangerously. He has been started on a medication called desmopressin that replaces the missing hormone. The parents want to understand what diabetes insipidus is, why he drinks so much, what the medication does, whether it is permanent, and what to do when he is sick or cannot drink. Explain clearly, check understanding, and agree a safety-net plan. [2]
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- [1]Adrogué HJ; Madias NE Hyponatremia. N Engl J Med, 2000.PMID 10824078
- [2]Adrogué HJ; Madias NE Hypernatremia. N Engl J Med, 2000.PMID 10816188
- [5]Sterns RH Disorders of plasma sodium--causes, consequences, and correction. N Engl J Med, 2015.PMID 25551526