Abstract
Central diabetes insipidus (DI) is a known complication following surgical resection of a suprasellar mass. There are limited data analyzing the outcomes of a standardized protocol for the management of postoperative DI in the pediatric population. We sought to fill this gap and hypothesized that utilizing a standardized protocol for fluid management (3-bag system) would reduce serum sodium fluctuations in the postoperative period after suprasellar surgery. A retrospective chart review was performed. Patients were identified with the following criteria: age≤18 years, undergoing a surgical procedure for suprasellar mass that also had postoperative DI. The primary outcome was the variability in serum sodium during the first 48h and between 48 and 120h postoperatively. There were 21 encounters pre-protocol and 22 encounters post-protocol for neurosurgical procedures. Use of the standardized protocol was associated with a lower range of sodium within 48h postoperatively (p=0.065) and 83% lower odds of hypernatremia (Na>150mmol/L) within 48h postoperatively (CI 0.039-0.714) after controlling for age, gender, and prior DI diagnosis. History of DI conferred a lower risk of hypernatremia as well as less sodium fluctuation within 48h postoperatively. Younger patients, those <9.7 years of age were associated with increased risk of hyponatremia and greater sodium fluctuations during the postoperative period. In patients with postoperative DI after suprasellar surgery, using a standardized protocol for fluid management (3-bag system) appears to reduce serum sodium variability in the first 48h after surgery.
Highlights
Central diabetes insipidus (DI) is a known complication following surgical resection of an intracranial mass, around the sellar and parasellar regions of the brain [1, 2]
Use of the standardized protocol was associated with a lower range of sodium within 48 h postoperatively (p=0.065) and 83% lower odds of hypernatremia (Na>150 mmol/L) within 48 h postoperatively (CI 0.039–0.714) after controlling for age, gender, and prior DI diagnosis
We found the incidence of new-onset DI in patients undergoing first-time surgical tumor resection to be 64%
Summary
Central diabetes insipidus (DI) is a known complication following surgical resection of an intracranial mass, around the sellar and parasellar regions of the brain [1, 2] Tumors in these locations account for approximately 10% of pediatric brain tumors with craniopharyngiomas being the most common with an incidence of 1.3 cases per million-person years [3, 4]. The diagnosis is made by decisive laboratory findings of elevated serum sodium (>145 mmol/L), elevated serum osmolality (>300 mmol/L), and inappropriately low urine osmolality (
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
