Diabetes insipidus

 

You have concerns for diabetes insipidus (DI). Discuss DI in relation to a postoperative neurosurgical patient. What are the signs and symptoms leading to your concerns? How would you manage the patient? What further complications could be caused from DI?

Sample Solution

Diabetes insipidus

Diabetes insipidus (DI) occurs commonly in the acute phase of neurosurgical insults such as pituitary surgery, SAH, and TBI. Many neurosurgical patients have a diminished consciousness level because of brain injury, postoperative cerebral irritation, cerebral edema, sedation for airway management, or a combination of these factors. Hence, their awareness of thirst or their ability to respond to it by ingesting fluids may be diminished or absent, and they are vulnerable to the development of severe hypernatremia. Postoperative diabetes insipidus characteristically occurs within 2 days of surgery, with the abrupt onset of hypotonic polyuria and thirst (if the patient is not unconscious or cognitively impaired). Most cases resolve by the third postoperative day, with a minority progressing to persistent diabetes insipidus.

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