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Nephrogenic DI — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

HardEndocrineNephrogenic DIRACP Paediatrics

A 4-year-old with confirmed nephrogenic diabetes insipidus is fasted for urgent surgery. Sodium is 146 mmol/L and urine output remains high. What peri-operative plan most safely prevents deterioration?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Replace unavailable oral water intravenously and monitor hydration biochemically

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as E

D is correct because a child with nephrogenic DI who cannot drink needs planned intravenous free-water replacement and frequent biochemical and balance review. E creates rapid hypernatraemic dehydration. A is ineffective in nephrogenic DI and fluid restriction is dangerous. B can add excessive sodium and ignores changing losses. C can increase renal solute and water loss; chronic thiazide-based strategies do not replace acute access to water.

Reference: Royal Children’s Hospital Melbourne, Diabetes insipidus: https://www.rch.org.au/clinicalguide/guideline_index/Diabetes_insipidus/