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DOI: 10.1055/s-0038-1646248
Water imbalance after neurosurgery: A case report
Publication History
Publication Date:
09 May 2018 (online)
Introduction: We describe a 30-year-old woman, who developed triphasic response after resection of craniopharyngeoma. Case Summary: A 30-year-old female with no co-morbidity and no endocrine abnormality was operated for craniopharyngeoma while leaving the pituitary stalk intact (according to the surgical notes). Postopeartive she was conscious, cooperative without any neurodeficit. Soon, she started passing urine amounting to 300 ml/hr on an average. Urine osmolarity was 136 mosm/kg and serum sodium 140 meq/l. Being normoglycaemic and not on any diuretics a diagnosis of central diabetes insipidus was made. She received Desmopressin nasal spray and was advised to drink water ad libitum. Gradually, as the urine output came down over the next day desmopressin was discontinued. On the third day sodium was 125 meq/ml and Serum osmolarity was 257 mosm/kg. SIADH was diagnosed and fluids were restricted. Her sodium continued to fall and she experienced seizure. At this juncture she was administered hypertonic saline. Over the next 24 hours urine output again started increasing showing a osmolarity of 70 mosm/kg and sodium rising to 145 meq/l. She was put back on desmopressin nasal spray which controlled the urine output to some extent. However, as she continued to remain polyuric at discharge she was advised desmopressin tablets 0.1 bd with regular monitoring of sodium and water intake ad libitum. Conclusion: The pathophysiology of the triphasic response is well known. Predisposing factors may be the disease or surgery intraoperative CSF leak. Successful prevention requires an index of suspicion and proactive measures.