FRI354 Therapeutic Potential Of Oxcarbazepine In Central Diabetes Insipidus

Disclosure: S. Pittampalli: None. V. Pattan: None. D. Das: None. U. Munasinghe: None. Introduction: Postoperative central Diabetes insipidus is usually transient but can be persistent. Persistent central Diabetes insipidus is prone to dose fluctuations in clinically unstable patients, especially when concomitant medications influence sodium and water homeostasis. Clinical Case: A 24-year-old female with headache and confusion had sellar and suprasellar mass of 6 cm x 4 cm with moderate to severe hydrocephalus and underwent Right craniotomy with debulking of the mass and pathology showed pilocytic astrocytoma. Postoperative course was complicated by short-term memory loss, right-sided weakness, adrenal insufficiency, and visual impairment. Repeat imaging showed increased size of suprasellar mass consequently requiring a transnasal transphenoidal resection. Post-operative neurological worsening was noted along with diffuse subarachnoid/ intraventricular hemorrhage with intraparenchymal hematoma in the right frontal lobe on CTA head. Hospital course included tracheostomy with mechanical ventilation. She had panhypopituitarism including CDI. CDI was initially managed by DDAVP 10mcg intranasal nightly and free water flushes. She had central adrenal insufficiency and central hypothyroidism treated by hydrocortisone and levothyroxine respectively. Hospital stay lasted for several months with multiple adjustments to the DDAVP dosage and free water flushes due to fluctuating serum sodium levels. She was started on levetiracetam 750 mg twice daily and oxcarbazepine 300 mg twice daily for seizure like activity. After two months, the oxcarbazepine dose was increased to 450 mg twice daily and later to 600 mg twice daily for breakthrough seizures. DDAVP was then discontinued as she developed hyponatremia. The dose of oxcarbazepine was reduced to 450 mg twice daily and she was subsequently discharged to a facility off DDAVP. Discussion: Postoperative CDI managed by DDAVP was complicated with oxcarbazepine-induced hyponatremia. CDI and sodium levels were controlled with oxcarbazepine after DDAVP discontinuation. Thus, oxcarbazepine has therapeutic potential as an antidiuretic agent as it can stimulate collecting tubule V2 receptor - G protein complex independent of ADH. Presentation: Friday, June 16, 2023