Evaluating a standardized protocol for the management of diabetes insipidus in pediatric neurosurgical patients

Area of Science:

• Pediatric Neurosurgery
• Pediatric Endocrinology
• Critical Care Medicine

Background:

• Central diabetes insipidus (DI) is a frequent complication after suprasellar mass resection.
• Limited data exist on standardized management protocols for pediatric postoperative DI.
• Suprasellar surgery poses risks for hormonal and fluid balance disturbances.

Purpose of the Study:

• To evaluate the efficacy of a standardized 3-bag fluid management protocol in pediatric patients with DI post-suprasellar surgery.
• To assess the impact of the protocol on serum sodium variability and electrolyte imbalances.
• To identify patient factors influencing postoperative DI outcomes.

Main Methods:

• Retrospective chart review of pediatric patients (≤18 years) with DI after suprasellar mass resection.
• Comparison of outcomes between pre-protocol and post-protocol implementation of a standardized fluid management system.
• Primary outcome: serum sodium variability within the first 48 and 48–120 hours postoperatively.

Main Results:

• The standardized protocol was associated with reduced serum sodium range within 48 hours postoperatively (p=0.065).
• An 83% lower odds of hypernatremia (Na>150 mmol/L) within 48 hours was observed with the protocol.
• Younger age (<9.7 years) correlated with increased risk of hyponatremia and greater sodium fluctuations.

Conclusions:

• A standardized 3-bag fluid management protocol effectively reduces serum sodium variability in the initial 48 hours post-suprasellar surgery in pediatric patients with DI.
• The protocol demonstrates a significant benefit in mitigating hypernatremia risk.
• Understanding patient-specific factors like age is crucial for managing postoperative DI.