Nephrogenic diabetes insipidus associated with prolonged sedation with sevoflurane in the intensive care unit

Sevoflurane and nephrogenic diabetes insipidus on the rise: copeptin to the rescue?

“…These findings confirmed the results of an earlier study by Timper et al [2]. While the authors claim that the incidence of NDI remains very low, this may change with the increasing use of sevoflurane in ICU, which appears to be effective in reducing wake-up and extubation times and was recently described for sedation in acute respiratory distress syndrome [3]. In a recent retrospective study, of the 35 patients receiving sevoflurane, seven patients presented with NDI during their ICU stay (i.e., 20%) [3].…”

“…While the authors claim that the incidence of NDI remains very low, this may change with the increasing use of sevoflurane in ICU, which appears to be effective in reducing wake-up and extubation times and was recently described for sedation in acute respiratory distress syndrome [3]. In a recent retrospective study, of the 35 patients receiving sevoflurane, seven patients presented with NDI during their ICU stay (i.e., 20%) [3]. The main finding of this study was that sevoflurane sedation in ICU was associated with NDI in relation to concentration and duration of exposure.…”

“…The differential diagnosis between NDI and CDI can be problematic as both groups may present with neurological problems [1]. Only a trial dose of desmopressin could differentiate as most but not all with NDI will remain unresponsive [3, 4]. Copeptin may resolve the diagnosis dilemma [1] allowing institution of appropriate treatment, either by removal of the cause (sevoflurane) or the treatment of the causality (brain edema, cerebral bleeding, etc.).…”

Sevoflurane, a sigh of relief in COVID-19?

“…Cabibel and colleagues 11 reported three cases in which development of NDI was associated with prolonged (4, 6, and 13 days) sedation with sevoflurane (1.0 vol%). In a retrospective study, L'Heud e and colleagues 12 analysed ICU patients who developed NDI and were exposed to longer duration (178 [118e261] h vs 66 [20e119] h; P<0.01) and higher doses (1.3 [1.2e1.5] vol% vs 1 [0.8e1.2] vol% P¼0.02) of sevoflurane. However robust data on the safety of long-term use of volatile anaesthetics are missing.…”

Intraoperative Polyuria Following Sevoflurane Administration

“…Polyuria following administration of sevoflurane had been described in some case reports (4)(5)(6)(7). The following is a recent case report detailing a patient who developed polyuria following intraoperative use of sevoflurane.…”