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We do not recommend population screening for diabetes insipidus (DI) (B3). We recommend to perform diagnostic testing for central diabetes insipidus (CDI) in patients who underwent neurosurgery, after skull and brain trauma, subarchnoid hemorrhage (B3). We recommend excluding thirst impairment during all stages of diagnostic assessment (С3). We recommend excluding DI in cases of persistent hypotonic polyuria: excretion of more than 3 L. or more than 40 mL/kg of urine daily; urine osmolality less than 300 mOsm/kg or urinary specific gravity less than 1004 g/L in all urine samples or during Zimnitsky test (В3). After hypotonic polyuria is confirmed, we recommend excluding of the main causes of nephrogenic diabetes insipidus (NDI) (B3). We recommend simultaneous measurement of urine osmolality and blood osmolality/sodium level in order to confirm DI. Blood hyperosmolality (more than 300 mOsm/kg) and/or hypernatremia with low urine osmolality (less than 300 mOsm/kg) confirms DI (B2). If testing does not reveal these findings, we recommend performing a fluid deprivation test to exclude primary polydipsia (PP) (B2). Desmopressin test is recommended to distinguish CDI and NDI (B2). In cases of CDI we recommend to perform head MRI with contrast (B3). In cases of NDI we recommend assessing renal structure and function and possible electrolyte disturbances (C3). In cases of PP we recommend to refer a patient to psychiatrist (B3). We recommend treating CDI with synthetic vasopressin analogue – desmopressin (B1). We recommend an individual approach in choosing desmopressin dosage form (B2). As the initial dose is difficult to predict when starting desmopressin treatment, we recommend titrating the dosage using two approaches: “the average dose” and “as required” (C4). We recommend educating the patients to ensure knowledge of the features of various desmopressin dosage forms (C4). To decrease the risk of water intoxication, we recommend educating the patients to the water intake regimen adherence (С4). When CDI is accompanied by thirst impairment, we recommend titrating the dose in a clinical setting, with assessment of blood sodium, bodyweight and/or urine volume (C4).

Evaluation of consistent properties is an important and integral part of investigations on the creation of semisolid nasal pharmacotherapeutic agents. The aim of this work is the study of consistent properties of developed nasal semisolid dosage form with synthetic analogue of vasopressin – arginine-vasopressin for the treatment of cognitive consequences of cerebral-vascular pathology. Materials and methods. The study of structural-mechanical characteristics of nasal ointment with 0.000005% arginine-vasopressin on the vaseline-lanolin-paraffin base was carried out by a rotary viscosimeter «Reotest-2» with cylindrical arrangement. It was established that consistent properties of arginine-vasopressin semisolid dosage form and «mechanical stability» (2.56) describe composition as a thixotropic system which provides with restorability after applying tension and allow to predict stability of consistent properties during a long-term storage. Calculated factors of dynamical flowing of arginine- vasopressin dosage form on the vaseline-lanolin-paraffin base (Кd1=28.7%; Kd2=53.84%) quantitatively confirm satisfactory spreading degree of the system during application on the mucous membranes or in manufacturing process. Conclusions. The studies of consistent properties of nasal ointment with synthetic analogue of vasopressin – arginine-vasopressin 0.000005% on lipophilic basis for treatment of cognitive effects of cerebrovascular disease have been conducted by rotary viscometer «Reotest 2». It has been established that consistent properties of studied soft nasal dosage form of arginine-vasopressin and «mechanical stability» value of the system (2.56) characterize it as a thixotropic, that assure recovery from mechanical stress, that allows to predict the stability of consistent properties of the composition during prolonged storage. The calculated values of coefficients of dynamic flow of intranasal dosage form of arginine-vasopressin on vaseline-lanolin-paraffin base (Кd1=28.7%; Kd2=53.84%) quantitatively confirm satisfactory level of system distribution during application on mucous membranes or at manufacturing process operations.