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• W2327242028 abstract "Introduction: Diabetes Insipidus (DI) is a common complication of skull based tumor resection and manifests as polyuria causing hypovolemic hypernatremia. Cerebral vasospasm is a rare complication of craniopharyngioma resection. Post operative management of DI usually requires careful monitoring of urine output, urine specific gravity and serum sodium in order to determine a stable dose of replacement arginine vasopressin (ddAVP) required to maintain physiological euvolemia and eunatremia. Typical management of vasospasm involves induced hypertension and aggressive euvolemia usually accomplished using vasopressors and fluid administration. Both of these processes have the potential of confounding volume and sodium status in DI. We review the clinical case of a 26 year old patient who underwent craniopharyngioma resection. DI was observed on postoperative day 1 and was treated with PRN desmopressin and free water boluses. A stable ddAVP dose was established by postoperative day 8. On postoperative day 11, the patient was noted to have decreased mental status. After a CT head and EEG negative for acute pathology, Transcranial Dopplers were done that showed high mean flow velocities. Cerebral vasospasm was confirmed with CT angiography. Initial treatment was undertaken with normal saline boluses and vasopressors resulting in wide fluctuations in sodium and volume state. Then a standardized regimen was instituted with high volume maintenance using normal saline coupled with 3% saline infusion titrated based on serum sodium measurements every 4 hours. ddAVP dose was kept consistent. This regimen allowed for normalization of serum sodium concentrations while maintaining mean arterial pressure and cerebral perfusion pressure within goal parameters. While cerebral vasospasm in the setting of diabetes insipidus is itself a rare and unique phenomenon, we believe our case describes a unique strategy of management of fluid and solute requirements of this uniquely challenging patient. We used a clinical approach of minimizing variability of therapeutic options with close monitoring to allow predictable fluid and solute shifts in fluid management of this patient. An algorithmic approach based simplified treatment regimens and thorough physiologic monitoring is emphasized in this case and is crucial to successful management of such a challenging scenario" @default.
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• W2327242028 date "2013-12-01" @default.
• W2327242028 modified "2023-10-14" @default.
• W2327242028 title "1281" @default.
• W2327242028 doi "https://doi.org/10.1097/01.ccm.0000440513.67174.3d" @default.
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