Nephrogenic diabetes insipidus diagnosed only after onset of hypernatremia in a patient who had undergone emergency surgery

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  • 緊急手術後の高ナトリウム血症で判明した腎性尿崩症の一例

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We report here a case of nephrogenic diabetes insipidus revealed only after hospitalization for trauma. A 27-year-old man with open fractures was admitted for emergency surgery. The patient was fasted preoperatively and received crystalloid solution intra- and postoperatively. He had presented with polyuria on arrival and serum sodium levels subsequently increased to 161 mEq/l at 18 hours after arrival. At the same time, diabetes insipidus was suspected from the massive amounts of dilute urine and hypernatremia. Crystalloid solution was replaced with 5% glucose and oral intake was resumed, which gradually alleviated the hypernatremia. He did not respond to desmopressin and was subsequently diagnosed with nephrogenic diabetes insipidus (NDI) by the water restriction test. It became apparent that the patient had polydipsia from early childhood and actually had congenital NDI. Infusion of crystalloid accompanied by cessation of oral intake would rapidly lead to hypernatremia and hyperosmolar dehydration in NDI and can leave neurological sequelae in severe cases. Fluid management in the perioperative period is also challenging. NDI is not a common disorder, but can result in serious adverse outcome if not noticed in the emergency department. Emergency physicians should be cognizant of this disorder to ensure that life-threatening situations are avoided.

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