Perioperative Diabetes Insipidus: Report of two unusual cases

Abstract Diabetes insipidus (DI) is a rare clinical condition in the post-operative period. Post-surgery polyuria is a common finding, as body excretes the excessive fluid given during surgery. It is important to diagnose and differentiate the DI from post-operative polyuria, as DI can lead to severe dehydration and electrolyte disturbances. We report two unusual cases of perioperative DI requiring desmopressin therapy. Case1: A 46-year-old healthy male patient developed intraoperative DI leading to hypernatremia during the anterior cervical discectomy and fusion. Anaesthesia was maintained with propofol and remifentanil target-controlled infusion (TCI). After two hours of surgery, patient became polyuric and was passing diluted urine. He received desmopressin and hydration. Patient recovered, was transferred to the ward and discharged home without any clinical or neurological problems. Case2: 36 years healthy male patient underwent elective 3rd ventricular cyst excision. Pre-anaesthesia assessment did not reveal any comorbidities and the surgery was uneventful. His anesthesia was maintained with propofol and remifentanil TCI (target-controlled infusion). In the post-operative period, he developed DI requiring hydration and desmopressin. Patient’s further recovery was uneventful. He was discharged home through ward. Conclusion: The occurrence of DI in above mentioned surgeries is very rare. Both surgical procedure and anaesthesia medications can cause perioperative DI.