"When the excision of the tumor is planned after hormonal work up, many a times perioperatively electrolyte abnormalities are ignored. Though the complications and predictors related to water and electrolyte homeostasis following pituitary surgery in general and craniopharyngioma surgery in particular is well known, there is paucity of data regarding the choice of intraoperative fluid. Studies have addressed the type of postoperative fluids with controversial results. "
[Show abstract][Hide abstract] ABSTRACT: Background:
Electrolyte imbalance and acute diabetes insipidus (DI) are the most common complications in patients undergoing craniopharyngioma surgery. Improper management of water and electrolyte imbalance is common cause of morbidity and mortality. Data is sparse and controversial regarding the choice of fluid therapy in this population during perioperative period.
In this retrospective-prospective study involving 73 patients (58 retrospective), the type of fluid therapy was correlated with occurrence of hypernatremia, hyponatremia, DI, morbidity, and mortality. In the retrospective study, 48 patients received normal saline and 10 received mixed fluids as per the prevailing practice. In the prospective group, five patients each received normal saline, half normal saline, and 5% dextrose randomly.
The sodium values were significantly higher in first 48 h in the group that received normal saline compared with other groups (P < 0.001). The use of normal saline was associated with higher incidence of hypernatremia, DI, and mortality (P = 0.05), while the group that received 5% dextrose was associated with hyponatremia, hypoglycemia, and seizures. There was no perioperative hypotension with use of any of the fluids.
Our results indicate half normal saline was fluid of choice with diminished incidence of water and electrolyte abnormalities without increase in mortality during postoperative period.
Surgical Neurology International 07/2014; 5:105. DOI:10.4103/2152-7806.136399 · 1.18 Impact Factor
"These organic osmolytes are protective against damages to proteins or DNA from increased ion strength within cells. DI is a disorder characterized by the inability to concentrate urine due to the inability of the hypothalamus to secrete an adequate amount of ADH (neurogenic DI) (Jane et al., 2006) or from a defect in the kidney response to ADH (nephrogenic DI) (Bichet, 2006) (Table 23.5). In both cases, there is excretion of large volumes of diluted urine. "
[Show abstract][Hide abstract] ABSTRACT: Electrolyte and acid-base disturbances are common occurrences in daily clinical practice. Although these abnormalities can be readily ascertained from routine laboratory findings, only specific clinical correlates may attest as to their significance. Among a wide phenotypic spectrum, acute electrolyte and acid-base disturbances may affect the peripheral nervous system as arreflexic weakness (hypermagnesemia, hyperkalemia, and hypophosphatemia), the central nervous system as epileptic encephalopathies (hypomagnesemia, dysnatremias, and hypocalcemia), or both as a mixture of encephalopathy and weakness or paresthesias (hypocalcemia, alkalosis). Disabling complications may develop not only when these derangements are overlooked and left untreated (e.g., visual loss from intracranial hypertension in respiratory or metabolic acidosis; quadriplegia with respiratory insufficiency in hypermagnesemia) but also when they are inappropriately managed (e.g., central pontine myelinolisis when rapidly correcting hyponatremia; cardiac arrhythmias when aggressively correcting hypo- or hyperkalemia). Therefore prompt identification of the specific neurometabolic syndromes is critical to correct the causative electrolyte or acid-base disturbances and prevent permanent central or peripheral nervous system injury. This chapter reviews the pathophysiology, clinical investigations, clinical phenotypes, and current management strategies in disorders resulting from alterations in the plasma concentration of sodium, potassium, calcium, magnesium, and phosphorus as well as from acidemia and alkalemia.
Handbook of Clinical Neurology 01/2014; 119:365-82. DOI:10.1016/B978-0-7020-4086-3.00023-0
"Diarrhoea resolved following institution of pergolide treatment suggesting that colonic floral imbalance might have been present as a result of immunocompromise. Human patients with DI tend to develop constipation in the face of prodigious water consumption (Jane et al. 2006). Diarrhoea resolved in the face of ongoing severe polydipsia following discharge from the VMTH in our case, suggesting that it may not have been a result of increased water intake. "
[Show abstract][Hide abstract] ABSTRACT: Central diabetes insipidus (DI) was diagnosed in a 20-year-old American Quarter Horse gelding that was concomitantly affected with pituitary pars intermedia dysfunction (PPID). The diagnosis of DI was supported by a positive response to administered desmopressin acetate. Diagnosis of PPID was supported by physical appearance and elevated plasma adrenocorticotropic hormone concentration following domperidone administration. The horse's physical condition improved following treatment with pergolide but long-term treatment with desmopressin was not undertaken and severe polyuria and polydipsia persisted. Desmopressin acetate appears to be useful for the diagnosis of DI in mature horses concomitantly affected with PPID.
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