Polyuria in Neurocritical Care – a Case Report

Česká verzia

Authors: V. Špatenková ¹; P. Škrabálek ²
Authors place of work: Krajská nemocnice Liberec, a. s. Neurocentrum, Neurointenzivní jednotka ¹; Krajská nemocnice Liberec, a. s. Oddělení klinické biochemie ²
Published in the journal: Cesk Slov Neurol N 2014; 77/110(5): 647-649
Category: Case Report

Summary

Polyuria is often seen in neurocritical care patients and can cause severe water and sodium imbalance. There are two major mechanisms causing the loss of water via the kidneys. The loss may be either due to osmotic or water diuresis. Central diabetes insipidus is a typical water diuresis, with free water losses causing hypernatremia in acute brain disease. Sodium diuresis occurs in cerebral salt wasting syndrome and causes hypoosmolal hyponatremia. One of the aims of neurocritical care is to prevent iatrogenic dysnatremias by careful management of polyuria. This requires correct diagnosis of the type of diuresis and differentiation of the possible cause – whether this is the organism’s compensatory response to higher fluid or osmotic agent intake or acute brain damage. We present a case of a 34‑year‑ old female patient with subarachnoid hemorrhage and iatrogenic hypoosmolal hyponatremia, iatrogenic drug‑associated SIADH (syndrome of inappropriate secretion of antidiuretic hormone) caused by erroneous administration of desmopressine acetate in polyuria with free water diuresis.

Key words:
polyuria – hyponatremia – hyper-natremia – neurocritical care

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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