In Reply.—We thank Dr Rockoff for his reminder of the clinical significance of recognizing and treating DI in the child with brain death when organ transplantation is anticipated. Children with brain death and DI would be placed in the category we labeled terminal events. We chose that title because there are some children with serious central nervous system insults who never meet the exact criteria for brain death, yet in whom DI develops during their last hours. Neither of the two children we placed in that category was declared to have brain death before the heart rate ceased spontaneously.
After severe central nervous system insults, cerebral circulation does not have to be totally absent before one can see compromise of the circulation to the hypothalamic-pituitary axis, resulting in decreased production and release of vasopressin. Drs Rockoff and Outwater suggested that no children have been described who had hypoxic-ischemic brain