Renal losses

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a. Central diabetes insipidus. Results from inadequate production of antidiuretic hormone (ADH). If child's access to water is hampered or thirst mechanism is affected, hypernatremia occurs. May be idiopathic, hereditary (eg, Wolfram syndrome), or caused by tumors, trauma, infections (eg, meningitis), granulomas (eg, sarcoidosis), or vascular conditions (eg, cerebral aneurysm).

b. Nephrogenic diabetes insipidus. Results from insensitivi-ty of the renal collecting duct to ADH. Disease may be congenital (X-linked or autosomal dominant) or acquired due to drugs (eg, lithium), sickle cell disease, chronic renal disease (eg, obstructive uropathy), hypokalemia, or hypercalcemia.

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