Vina Wira, Agung Triono, Tunjung Wibowo, Setya Wandita, Ekawaty Lutfia Haksari, Madarina Julia
Objective: Central diabetes insipidus (CDI) in neonates is extremely rare. One of the possible cause is hydrocephalus as a complication of congenital toxoplasmosis. We report neonatal CDI due to congenital toxoplasmosis and its management. Case: A 36 week-female baby was born to a multigravida mother through caesarian section indicated by premature rupture of the membrane. The baby was vigorous at birth with birth weight of 2.100 gram. She was referred from district hospital at 41 weeks and 4 days of corrected age due to lethargic. She looked lethargic, yellowish, and had feeding intolerance. Observation in the neonatal ward revealed a history of dehydration, polyuria (diuresis of 6.3-12.5 cc/kgBW/hour), hypernatremia (162-169 mmol/L; normal range 135-145 mmol/L), low urine osmolality of 62.98 mOsm/kg (normal range <300mOsm/L), and IgM anti toxoplasma of 1.35 UI/mL (normal range <0.55 UI/mL). Head ultrasound and head computed tomography scan exhibited hydrocephalus. The diagnosis of CDI was established at 11th day of admission and intravenous vasopressin 0.0005 unit/kgBW/hour up titration to 0.002 unit/kgBW/hour was initiated. The management of toxoplasmosis included sulfadoxine and pyrimethamine at 22nd day of admission after platelet count was 92.000/mm3. Natrium level and diuresis responded to intravenous vasopressin for 25 days. The treatment was subsequently altered to oral desmopressin. The baby showed a good response to this treatment. Conclusion: The presence of CDI should be considered in neonates with congenital toxoplasmosis.