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Dexmedetomidine-associated diabetes insipidus during skull base surgery in a pediatric patient
Emily G Reynolds1, Lauren M Van Decar2,3, Emily E Sharpe4
1Mayo Clinic School of Medicine, Scottsdale, Arizona, USA.
Insights
Dexmedetomidine may cause transient diabetes insipidus in pediatric patients undergoing surgery. This condition, marked by excessive urination, resolved after discontinuing the anesthetic, highlighting a rare intraoperative complication.
Area of Science:
- Anesthesiology
- Pediatric Endocrinology
- Neurosurgery
Background:
- Diabetes insipidus (DI) is a condition of water imbalance causing polyuria.
- Intraoperative anesthetics are a known cause of DI in adults, but rarely in pediatrics.
- Juvenile nasopharyngeal angiofibromas are benign tumors requiring surgical intervention.
Observation:
- A 16-year-old male presented with polyuria during surgery for a recurrent nasopharyngeal angiofibroma.
- The patient received dexmedetomidine, an anesthetic agent.
- Intraoperative polyuria suggested a diagnosis of diabetes insipidus.
Findings:
- Discontinuation of dexmedetomidine led to a significant decrease in urine output.
- The patient's water balance normalized within 24 hours post-administration.
- This case suggests dexmedetomidine as a potential cause of transient DI in pediatric surgical patients.
Implications:
- Highlights a rare pediatric complication of dexmedetomidine use.
- Suggests monitoring for DI in pediatric patients receiving dexmedetomidine during surgery.
- Informs anesthetic management for pediatric patients with nasopharyngeal angiofibromas.
Abstract:
Diabetes insipidus is characterized by polyuria due to an inability to auto-regulate water balance resulting in dangerous metabolic derangements. Intraoperative anesthetics have been increasingly identified as a cause of diabetes insipidus in adult patients; however, it is rare in pediatrics. We present a case of a 16-year-old male undergoing resection of a recurrent left juvenile nasopharyngeal angiofibroma who experienced intraoperative polyuria concerning diabetes insipidus. Urine output drastically decreased following discontinuation of dexmedetomidine with complete resolution within 24 h. We conclude that this case of transient diabetes insipidus was associated with dexmedetomidine administration.
