Diabetes insipidus chlorpropamide

Nephrogenic diabetes insipidus is due to resistance to action of vasopressin, and therefore DDAVP is not indicated, but some benefit may be gained by using thiazide diuretics or chlorpropamide. The syndrome of inappropriate antidiuretic hormone (SIADH) can be treated by using the antibiotic derivative demeclocycline to induce a state of vasopressin resistance and partial nephrogenic diabetes insipidus. 

Chlorpropamide Diabinese) has a relatively slow onset of action, with its maximal hypoglycemic potential often not reached for 1 or 2 weeks. Similarly, several weeks may be required to eliminate the drug after discontinuation of therapy. This drug can cause flushing, particularly when taken with alcohol, and can also cause hyponatremia. This effect has been employed to treat some patients who have partial central diabetes insipidus, an unrelated condition due to a pituitary ADH deficiency. 

Transient diabetes insipidus was seen in a child born to a mother who took chlorpropamide during pregnancy (140). 

Uhrig JD, Hurley RM. Chlorpropamide in pregnancy and transient neonatal diabetes insipidus. Can Med Assoc J 1983 128(4) 368370-1. 

Rado JP. Evidence for permanent enhancement of residual ADH induced by antidiuretic agents (chlorpropamide, car-bamazepine, clofibrate) in patients with pituitary diabetes insipidus. Endokrinologie 1975 64(2) 217-22. 

Chlorpropamide (but not other sulphonylureas) and carbamazepine are effective in partial pituitary diabetes insipidus, i.e. some natural hormone production remains, because they act on the kidney potentiating the effect of vasopressin on the renal tubule. H5q oglycaemia may occur with chlorpropamide. 

Many drugs and other chemicals can adversely affect renal function by directly or indirectly affecting the reabsorption of electrolytes and water in the kidney. Chlorpropamide can enhance the secretion of ADH and promote the water conservation actions of the hormone, while lithium use can lead to a nephrogenic diabetes insipidus. NSAIDs block the formation of renal prostaglandins, which can result in hyperkalemia. Hyperkalemia may also result from the use of beta blockers, potassium-sparing diuretics, and cyclosporine. 

Other side effects of sulfonylureas include nausea and vomiting, cholestatic jaundice, agranulocytosis, aplastic and hemolytic anemias, generalized hypersensitivity reactions, and rashes. About 10-15% of patients who receive these drugs, particularly chlorpropamide, develop an alcohol-induced flush similar to that caused by disulfiram see Chapter 23). Sulfonylureas, especially chlorpropamide, may induce hyponatremia by potentiating the effects of vasopressin on the renal collecting duct see Chapter 29), and this effect on water retention has been used to therapeutic advantage in patients with mild forms of central diabetes insipidus. 

The client diagnosed with mild diabetes insipidus is prescribed chlorpropamide (Diabinese), a sulfonylurea. Which discharge instruction should the nurse teach the client ... 

Chlorpropamide is used in insulin-deficient states (diabetes meUitus) and vasopressin-deficient states (diabetes insipidus) but its mode of action in these two conditions is not thought to be identical. Peak and Horni-blow (43 ) describe recurrent hyponatrae-mic phases (with levels as low as 113 mmol/ 1) whenever more than 250 mg chlorpropamide was given to a diabetic woman who refused to use insulin. Even the combination of 250 mg chlorpropamide and 50 mg phen-formin appeared to have elicited hyponatrae-mia. The patient also had precordial pain and was decompensated, a factor which may have contributed to the toxic effect of chlorpropamide. Diuretics aggravated the hypona-traemia. Treatment with glibenclamide and frusemide achieved control of the diabetes without hyponatraemic episodes (see 44 ). 

An unexpected side effect (46 ) was the development of diabetes insipidus (with hypernatraemia) after suicidal ingestion of 40 tablets of 250 mg of chlorpropamide. The authors suggest an inhibitory effect by... 

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