scholarly journals Diabetes Insipidus Complicating Management in a Child with COVID-19 and Multiorgan System Failure: A Novel Use for Furosemide

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Sara D. Gungor ◽  
Robert P. Woroniecki ◽  
Erin Hulfish ◽  
Katherine V. Biagas
Keyword(s):  
Diabetes Insipidus ◽  
Fluid Balance ◽  
Serum Sodium ◽  
Distress Syndrome ◽  
High Volume ◽  
System Failure ◽  
Optimal Management ◽  
Thiazide Diuretics ◽  
Successful Management ◽  
Vasopressin Infusion

Judicious balance of fluids is needed for optimal management of acute respiratory distress syndrome (ARDS). Achieving optimal fluid balance is difficult in patients with disorders of fluid homeostasis such as diabetes insipidus (DI). There is little data on the use of Furosemide to aid in balancing fluid and electrolytes in patients with DI. Here, we present a critically ill 11-year-old female with developmental delay, septo-optic dysplasia, central DI, and respiratory failure secondary to COVID-19 ARDS. She required careful titration of a Vasopressin infusion in addition to IV Furosemide for successful management of fluid and electrolyte derangements. On admission, she demonstrated high-volume urine output with mild hypernatremia (serum sodium 156 mmol/L). Despite her maximum Vasopressin infusion rate of 8 mU/kg/hr, by day two of admission, she voided a total of 4 L resulting in severe hypernatremia (serum sodium 171 mmol/L). With continually high Vasopressin infusion rates, her overall fluid balance became increasingly net positive, although her hypernatremia persisted. Her ARDS continued to worsen. After 48 hours of the addition of intermittent Furosemide, successful diuresis along with resolution of hypernatremia was achieved. The combination of IV Furosemide with Vasopressin infusion resulted in tailored diuresis and more controlled titration of serum sodium levels than adjustment in Vasopressin and fluids alone. These results are in contradistinction to the published literature, which focuses on the use of thiazide diuretics in managing DI. This experience highlights the potential for loop diuretics to aid in establishing a desired fluid and electrolyte status in managing patients with both DI and ARDS.

scholarly journals An Unusual Case of Transient Diabetes Insipidus After Prolonged Vasopressin Infusion

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A572-A573
Author(s):  
Albert Chang ◽  
Dharscika Arudkumaran ◽  
Deviani Umadat ◽  
Deirdre A Cocks Eschler
Keyword(s):  
Septic Shock ◽  
Critical Care ◽  
Diabetes Insipidus ◽  
Serum Sodium ◽  
Urine Output ◽  
Care Setting ◽  
Critical Care Setting ◽  
Surgical Intensive Care Unit ◽  
Vasopressin Infusion ◽  
Neurosurgical Patients

Abstract Background: Vasopressin is a hormone produced in the hypothalamus and secreted by the posterior pituitary. Underproduction or resistance to vasopressin can lead to diabetes insipidus (DI) resulting in the imbalance of fluid status and serum sodium levels. Synthetic vasopressin is a common second line agent used in the critical care setting for its vasopressor effects with an added clinical benefit by increasing cerebral perfusion pressure. There have been reported cases of transient DI after discontinuation of vasopressin in neurosurgical patients, however only few cases have been reported in septic shock patients without neurological involvement. We present a case of transient DI during treatment for septic shock after attempts to wean off vasopressin infusion. Presentation: A 41-year-old female with history of type 2 diabetes mellitus, quadriplegia following a motor vehicle accident at age 11 was admitted to the surgical intensive care unit for urosepsis after placement of right ureteral stent. The patient was started on broad spectrum intravenous (IV) antibiotics and vasopressors norepinephrine and vasopressin. After 8 days of vasopressin treatment, with each effort to wean IV vasopressin, the patient was noted to have significant polyuria with urine output reaching as much as 800 mL/hr and increase in her serum sodium to a maximum of 148 mmol/L (n 145 mmol/L). During episodes of excessive diuresis, urine sodium reached 87 mmol/L, urine osmolality was 72 mOsm/kg (50-1400 mOsm/kg), and serum osmolality was 288 mOsm/kg (n 300 mOsm/kg). The patient received three doses of 1 microgram of desmopressin 24 hours apart while weaning off vasopressin. This helped slow excessive diuresis while also maintaining normal serum sodium levels. Urine output decreased to approximately 150 mL/hr after each administration of desmopressin. The serum sodium levels eventually stabilized between 135-140 mmol/L and urine output held steady around 200 cc/hr. The patient did not require additional desmopressin and was hemodynamically stable off all vasopressors. Discussion: The pathophysiology behind transient diabetes insipidus following vasopressin infusion is still unclear. It is known that in septic shock, there is depletion of vasopressin stores which suggests central DI. Yet, pharmacologic doses of vasopressin are speculated to downregulate V2 receptors in the renal distal convoluted tubules and collecting ducts which suggests nephrogenic DI. Our patient responded to desmopressin which indicates that she at least had a central component of DI. There is no consensus on the duration of vasopressin required to precipitate transient DI, but vasopressin infusion was administered for at least 24 hours in other cases prior to onset. We present a rare case of transient diabetes insipidus after prolonged vasopressin infusion that clinicians should be aware of in the critical care setting.

Serum Sodium Concentration Changes Are Related to Fluid Balance and Sweat Sodium Loss

2010 ◽  
Vol 42 (9) ◽  
pp. 1669-1674 ◽  
Author(s):  
MATTHEW D. PAHNKE ◽  
JOEL D. TRINITY ◽  
JEFFREY J. ZACHWIEJA ◽  
JOHN R. STOFAN ◽  
W. DOUGLAS HILLER ◽  
...  
Keyword(s):  
Fluid Balance ◽  
Serum Sodium ◽  
Sodium Concentration ◽  
Serum Sodium Concentration ◽  
Concentration Changes ◽  
Sodium Loss ◽  
Sweat Sodium

scholarly journals Successful management of SARS-CoV-2 acute respiratory distress syndrome and newly diagnosed acute lymphoblastic leukemia

2020 ◽  
Vol 4 (18) ◽  
pp. 4358-4361
Author(s):  
Lia Phillips ◽  
Jovana Pavisic ◽  
Dominder Kaur ◽  
N. Valerio Dorrello ◽  
Larisa Broglie ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Acute Lymphoblastic Leukemia ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Lymphoblastic Leukemia ◽  
Successful Management ◽  
Standard Chemotherapy ◽  
Key Points ◽  
New Diagnosis

Key Points Standard chemotherapy can still be used for new diagnosis of acute lymphoblastic leukemia in patients with SARS-CoV-2. Corticosteroid can be given safely to patients with SARS-CoV-2 presenting with acute respiratory distress syndrome and ALL.

scholarly journals Techniques for the Management of Failed Surgery for Fractures of the Neck of Femur

2017 ◽  
Vol 11 (1) ◽  
pp. 1223-1229
Author(s):  
Philip M Stott ◽  
Sunny Parikh
Keyword(s):  
Hip Fracture ◽  
High Volume ◽  
The Elderly ◽  
Normal Function ◽  
Optimal Management ◽  
Tips And Tricks ◽  
Neck Of Femur ◽  
Management Of Complications ◽  
Failed Surgery ◽  
Surgical Treatments

Background: The majority of modern surgical treatments for managing hip fracture in the elderly are successful and result in a very low rate of revision surgery. Subsequent operations are however occasionally necessary. Optimal management of complications such as infection, dislocation or failed fixation is critical in ensuring that this frail patient group is able to survive their treatment and return to near normal function. Methods: This paper is a discussion of techniques, tips and tricks from a high volume hip fracture unit Conclusion: This article is a technique-based guide to approaching the surgical management of failed hip fracture treatment and includes sections on revising both failed fixation and failed arthroplasty.

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