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Anesthesia and analgesia · Jan 2022
ReviewPerioperative Diabetes Insipidus Caused by Anesthetic Medications: A Review of the Literature.
Common anaesthetic agents, including propofol, dexmedetomidine, sevoflurane, ketamine & opioids, can rarely cause intraoperative diabetes insipidus.
pearl- Lauren M Van Decar, Emily G Reynolds, Emily E Sharpe, Monica W Harbell, Heidi E Kosiorek, and Molly B Kraus.
- From the Department of Anesthesiology and Perioperative Medicine.
- Anesth. Analg. 2022 Jan 1; 134 (1): 828982-89.
AbstractDiabetes insipidus (DI) is an uncommon perioperative complication that can occur secondary to medications or surgical manipulation and can cause significant hypovolemia and electrolyte abnormalities. We reviewed and evaluated the current literature and identified 29 cases of DI related to medications commonly used in anesthesia such as propofol, dexmedetomidine, sevoflurane, ketamine, and opioids. This review summarizes the case reports and frequency of DI with each medication and presents possible pathophysiology. Medication-induced DI should be included in the differential diagnosis when intraoperative polyuria is identified. Early identification, removal of the agent, and treatment of intraoperative DI are critical to minimize complications.Copyright © 2021 International Anesthesia Research Society.
Notes
Van Decar et al. on the diagnosis and management of intra-operative diabetes insipidus concludes:
For the average adult patient, urine output >125 mL/h is consistent with polyuria. Urinary osmolality and specific gravity should be obtained and levels <300 mOsm/kg and <1.003, respectively, are consistent with hypotonic urine.
It is prudent to rule out other causes of polyuria including hyperglycemia, uremia, or iatrogenic causes including diuretic or mannitol administration.
Serum electrolytes and osmolality should also be obtained, and a high sodium (>146 mmol/L) and plasma osmolality (>300 mOsm/kg) are typically seen with DI.
Treatment should focus on replacement of free water deficit with a balanced salt solution, pharmacotherapy including DDAVP or vasopressin as appropriate, and close monitoring of patient’s fluid and electrolyte status.
Daniel Jolley
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