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NDT Plus Advance Access first published online on August 29, 2009
This version published online on August 31, 2009
NDT Plus, doi:10.1093/ndtplus/sfp117
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© The Author 2009. Published by Oxford University Press [on behalf of the ERA-EDTA].
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Water balance disorders after neurosurgery: the triphasic response revisited

Ewout J. Hoorn and Robert Zietse

Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

Correspondence: Ewout J. Hoorn; E-mail: ejhoorn{at}gmail.com


  Abstract

Water balance disorders after neurosurgery are well recognized, but detailed reports of the triphasic response are scarce. We describe a 55-year-old woman, who developed the triphasic response with severe hyper- and hyponatraemia after resection of a suprasellar meningioma. The case illustrates how sudden and dramatic the changes in water balance after neurosurgery can be. The biochemical profile suggested central diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion. The underlying pathophysiology was further analysed using fractional excretions, measurements of renin, aldosterone and vasopressin and a metyrapone test. Diagnostic, therapeutic and preventive strategies for these intriguing but complex cases are proposed.

Key Words: diabetes insipidus • hypernatraemia • hyponatraemia • meningioma • SIADH

Received for publication June 22, 2009. Accepted for publication August 3, 2009.


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