title: Partial Nephrogenic Diabetes Insipidus in a Burned Patient Receiving Sevoflurane Sedation With an Anesthetic Conserving Device-A Case Report.
abstract: OBJECTIVE
  To describe a case of partial nephrogenic diabetes insipidus in a burned patient after prolonged delivery of low inspired concentrations of sevoflurane via an Anesthetic Conserving Device.
  
  
  METHODS
  Clinical observation.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Relevant clinical information.
  
  
  RESULTS
  A 34-year-old man was admitted with burns covering 52% of his total body surface area. Mechanical ventilation was provided during sedation with continuous infusions of sufentanil and midazolam. Sedation became increasingly difficult, and in order to limit administration of IV agents, sevoflurane was added to the inspiratory gas flow. This was provided using an Anesthetic Conserving Device and continued for 8 days. The patient rapidly developed polyuria and hypernatremia with an inappropriate decrease in urinary osmolality. Administration of desmopressin resulted in only a modest effect on renal concentrating ability. After cessation of sevoflurane, all variables returned to normal within 5 days. The results of further investigations (cerebral computed tomographic scan, cerebral magnetic resonance imaging, and serum arginine vasopressin concentration) were compatible with a diagnosis of partial nephrogenic diabetes insipidus. The temporal sequence of clinical findings in relation to sevoflurane administration suggests that the sevoflurane was the probable underlying cause.
  
  
  CONCLUSIONS
  Clinicians should be aware of the possibility of sevoflurane-induced diabetes insipidus not only during general anesthesia but also in the intensive care setting of sedation in critically ill patients. This is especially important in patients, such as those with severe burns, in whom preserved renal concentrating ability is important to ensure compensation for extrarenal fluid losses.
authors.affiliation: All authors: Burns Unit, Queen Astrid Military Hospital, Brussels, Belgium.
authors.forename: Marie
authors.initials: M
authors.lastname: Muyldermans
authors.forename: Serge
authors.initials: S
authors.lastname: Jennes
authors.forename: Stuart
authors.initials: S
authors.lastname: Morrison
authors.forename: Olivier
authors.initials: O
authors.lastname: Soete
authors.forename: Pierre-Michel
authors.initials: PM
authors.lastname: François
authors.forename: Elkana
authors.initials: E
authors.lastname: Keersebilck
authors.forename: Thomas
authors.initials: T
authors.lastname: Rose
authors.forename: Olivier
authors.initials: O
authors.lastname: Pantet
mesh_terms: D000328:Adult; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002056:Burns / Q000628:therapy*; D016292:Procedural Sedation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D003928:Diabetic Nephropathies / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000379:methods; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane