Perioperative management of diabetes insipidus in children [corrected]

Area of Science:

• Pediatric Endocrinology
• Neurosurgery
• Anesthesiology

Background:

• Perioperative management of diabetes insipidus (DI) in children is challenging, often leading to electrolyte imbalances due to fluid management issues.
• Existing approaches may not adequately address the complexities of DI in the surgical setting.

Purpose of the Study:

• To develop and prospectively evaluate a standardized, multidisciplinary protocol for perioperative management of pediatric diabetes insipidus.
• To compare the efficacy of this new protocol against historical controls in maintaining electrolyte balance.

Main Methods:

• A standardized protocol was implemented for 18 children with preoperative DI or at high risk for postoperative DI.
• Continuous intravenous aqueous vasopressin infusion was used for antidiuresis, with fluid restriction to two-thirds maintenance rate plus replacement volumes.
• Serum sodium levels were monitored closely, aiming for 130-150 mEq/L.

Main Results:

• The protocol successfully maintained perioperative serum sodium concentrations within the target range (130-150 mEq/L) without adverse effects.
• Children managed with the protocol showed a significantly smaller mean change in serum sodium (8.36 +/- 6.43 mEq/L) compared to historical controls (17.6 +/- 9.2 mEq/L).
• Hyponatremia occurred less frequently in the protocol group.

Conclusions:

• The developed multidisciplinary protocol provides a safe and effective method for managing pediatric patients with diabetes insipidus in the perioperative period.
• This standardized approach significantly improves peri-operative electrolyte balance and reduces the incidence of hyponatremia compared to historical management strategies.