A case of central diabetes insipidus after ketamine infusion during an external to internal carotid artery bypass

Gaffar, Sharib; Eskander, Jonathan P.; Beakley, Burton D.; McClure, Brian; Amenta, Peter S.; Pierre, Nakeisha

doi:10.1016/j.jclinane.2016.09.024

Cited by 14 publications

(9 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite this increased use, only 4 cases of DI associated with ketamine infusion have been described in the literature. 5 –8 To our knowledge, we report the first cases of delayed onset of central DI associated with ketamine analgesia.…”

Section: Discussionmentioning

confidence: 89%

“…To date, 4 case reports of ketamine-associated DI have been published. 5 –8 Sakai et al published the case of a 28-year-old man with intractable pain from a previous spinal cord injury. The patient, admitted for ketamine micro-drip analgesia, developed suspected central DI following ketamine (1-2 mg/kg/h).…”

Section: Discussionmentioning

confidence: 99%

“…Urine output decreased significantly upon desmopressin administration. 7 Most recently, Kataria et al published the case of a 42-year-old man status postexploratory laparotomy with splenectomy who received ketamine (0.12 mg/kg/h) for acute on chronic abdominal pain. Within 7 hours of ketamine initiation, the patient developed significant polyuria and polydipsia that resolved with ketamine discontinuation and desmopressin administration.…”

Section: Discussionmentioning

confidence: 99%

“…To date, there have been 4 published case reports of transient central diabetes insipidus (DI) occurring within 10 hours of ketamine initiation. 5 –8 Herein, we report 2 cases of delayed onset, ketamine-induced, transient central DI in patients cannulated for venovenous extracorporeal membranous oxygenation (VV ECMO) at our institution.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Delayed Onset of Central Diabetes Insipidus With Ketamine Sedation: A Report of 2 Cases

Herity

Baker

Kim

et al. 2019

Journal of Pharmacy Practice

View full text Add to dashboard Cite

Ketamine is being prescribed with greater frequency due to an emphasis on multimodal analgesia. With increasing use, uncommon adverse effects associated with ketamine are likely to surface. Limited reports of transient central diabetes insipidus (DI) occurring early after initiation (ie, within 10 hours) of ketamine have been reported. We present 2 cases of delayed onset (32 hours or more after initiation), ketamine-induced, transient central DI in patients cannulated for venovenous extracorporeal membranous oxygenation. No other causes of central DI were determined based upon physical examination or laboratory data, and both patients responded to treatment with desmopressin/vasopressin. The Naranjo adverse drug reaction probability scale noted a probable causation for each case. These cases demonstrate the possibility of a rare but serious complication of ketamine. Improvement after discontinuation of ketamine and administration of desmopressin/vasopressin appear to support a drug–effect association.

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Delayed Onset of Central Diabetes Insipidus With Ketamine Sedation: A Report of 2 Cases

Herity

Baker

Kim

et al. 2019

Journal of Pharmacy Practice

View full text Add to dashboard Cite

show abstract

“…10 Use of ketamine during anaesthesia also mentioned to cause diabetes insipidus. 11 Concluding line from our case reports is that apart from the surgical causes we have to consider anaesthesia medications as one of the aetiologies for the perioperative DI.…”

mentioning

confidence: 86%

Perioperative Diabetes Insipidus: Report of two unusual cases

Shaikh¹,

Zubair²,

Nawaz³

et al. 2020

Preprint

View full text Add to dashboard Cite

Diabetes insipidus (DI) is a rare clinical condition in the post-operative period. Post-surgery polyuria is a common finding, as body excretes the excessive fluid given during surgery. It is important to diagnose and differentiate the DI from post-operative polyuria, as DI can lead to severe dehydration and electrolyte disturbances. We report two unusual cases of perioperative DI requiring desmopressin therapy. Case1: A 46-year-old healthy male patient developed intraoperative DI leading to hypernatremia during the anterior cervical discectomy and fusion. Anaesthesia was maintained with propofol and remifentanil target-controlled infusion (TCI). After two hours of surgery, patient became polyuric and was passing diluted urine. He received desmopressin and hydration. Patient recovered, was transferred to the ward and discharged home without any clinical or neurological problems. Case2: 36 years healthy male patient underwent elective 3rd ventricular cyst excision. Pre-anaesthesia assessment did not reveal any comorbidities and the surgery was uneventful. His anesthesia was maintained with propofol and remifentanil TCI (target-controlled infusion). In the post-operative period, he developed DI requiring hydration and desmopressin. Patient’s further recovery was uneventful. He was discharged home through ward. Conclusion: The occurrence of DI in above mentioned surgeries is very rare. Both surgical procedure and anaesthesia medications can cause perioperative DI.

show abstract

Intra‐operative diabetes insipidus associated with cervical spine traction during staged scoliosis surgery

McCarthy

2020

Anaesthesia Reports

View full text Add to dashboard Cite

A 15-year-old boy with cerebral palsy and epilepsy presented for a posterior spinal fusion as part of staged repair of thoracolumbar scoliosis. Total intravenous anaesthesia was induced and maintained with propofol, remifentanil and ketamine. Following prone positioning, cervical traction was applied. Polyuria developed intra-operatively, from 4 to 18 ml.kg À1 .h À1. There was a corresponding rise in plasma sodium concentration from 132 to 145 mmol.l À1. Haemodynamic stability was maintained with boluses of Hartmann's solution and a noradrenaline infusion. Given the possibility of diabetes insipidus due to reduced cerebral perfusion pressure, the cervical traction was removed. This initially showed a good response with a transient reduction in polyuria to 3 ml.kg À1 .h À1 before rising to 8 ml.kg À1 .h À1. Subsequently, a vasopressin infusion was started with normalisation of diuresis and plasma sodium concentration by the end of surgery. Diabetes insipidus is an endocrine disorder related to lack of production or insensitivity to vasopressin. In the peri-operative period, it is mainly associated with pituitary surgery and rarely with spinal surgery. To the authors' knowledge, this is only the second report of diabetes insipidus associated with staged scoliosis surgery. Cervical traction should be considered as a potential cause of intra-operative diabetes insipidus.

show abstract

A case of central diabetes insipidus after ketamine infusion during an external to internal carotid artery bypass

Cited by 14 publications

References 7 publications

Delayed Onset of Central Diabetes Insipidus With Ketamine Sedation: A Report of 2 Cases

Delayed Onset of Central Diabetes Insipidus With Ketamine Sedation: A Report of 2 Cases

Perioperative Diabetes Insipidus: Report of two unusual cases

Intra‐operative diabetes insipidus associated with cervical spine traction during staged scoliosis surgery

Contact Info

Product

Resources

About