NEPHROGENIC DIABETES-INSIPIDUS SECONDARY TO LITHIUM-THERAPY IN THE POSTOPERATIVE-PATIENT - A CASE-REPORT

Nephrogenic diabetes insipidus (NDI) presents a rarely encountered but challenging fluid management problem in the perioperative period. Thi s case is that of a patient with a perforated duodenal ulcer and previ ously undiagnosed NDI who received standard preoperative and postopera tive hydration with normal saline, causing hypernatremia and an inappr opriate diuresis. The resulting hypernatremia and hyperosmolality requ ired aggressive hypotonic fluid replacement to return to preoperative values. Though refractory to 1-desamino-8-D-argenine-vasopressin (dDAV P), thiazide diuretics and nonsteroidal anti-inflammatory agents have a role in managing selected patients. Early diagnosis with careful flu id and electrolyte management are critical in successful management of these patients in the perioperative period.