Central Diabetes Insipidus: A Rare Perioperative Cause of Severe Hypernatraemia

Abstract

In this case report we describe the management of severe hypernatraemia following inadvertent water restriction. A 21-year-old woman with no reported medical history presented on transfer from an outside hospital with a complex volar upper extremity injury. Management both operatively and postoperatively involved a prolonged period of fasting which limited her access to drinking water. Collateral history revealed that she had previously drunk copious amounts of water during the course of any given day and this had served to alleviate the dramatic symptoms of hypernatraemia that were rapidly manifest when her normal intake was curtailed. We outline the fluid management, administration of desmopressin and her subsequent recovery. A literature review of the management of central diabetes insipidus is also covered.

Use of Audiovisual Assisted Therapeutic Ambience in Radiotherapy (AVATAR) for Anesthesia Avoidance in a Pediatric Patient With Down Syndrome

“…Fasting may be particularly problematic for patients with the comorbidity of diabetes insipidus and polydipsia, as it causes extreme discomfort and presents an increased risk of hypernatremia, 10 thus options to avoid anesthesia should be carefully considered in such patients. Furthermore, administration of anesthesia demands additional resources and personnel, and carries a significant additional monetary cost per session of radiation.…”