Management of diabetes insipidus during anesthesia for brain germinoma resection in a child : A case report

Jeon, Joon Pyo; Lee, Yoonki; Hong, Sang Hyun; Ryu, Keon Hee

Clinical Research

Neuroanesthesia

Anesthesia and Pain Medicine 2008;3(4):293-297.
Published online October 30, 2008.

Management of diabetes insipidus during anesthesia for brain germinoma resection in a child : A case report

Joon Pyo Jeon, Yoonki Lee, Sang Hyun Hong, Keon Hee Ryu

Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. yklee@catholic.ac.kr

Abstract

Diabetes insipidus caused by impaired production or reduced responses to vasopressin, can occasionally be seen postoperatively in neurosurgical patients, but rarely occurs during anesthesia and surgery. An 8-year old female patient with suprasellar germinoma was scheduled for tumor resection. Anesthesia was induced smoothly and maintained mainly with sevoflurane. Several hours after anesthesia and surgery, urine output was increased with increased serum sodium concentration, indicating the occurrence of diabetes insipidus. To prevent sodium increase and replace fluid loss, 2.5% dextrose half saline was used. Though sodium concentration did not increase further, the concomitant increase of glucose complicated anesthetic management. After the completion of anesthesia and surgery, serum sodium increased further but then gradually returned to normal with conservative management. The patient was discharged without any complications.

Key Words: diabetes insipidus, germinoma, hypernatremia