PDF(Pubmed)
Abstract：
Vasopressin infusion is commonly used in intensive care settings during states of advanced vasodilatory shock for its vasoconstrictive properties. Vasopressin also acts on renal tubular cell receptors in the collecting ducts of kidneys to allow for water reabsorption. The sudden discontinuation of vasopressin infusion can lead to the development of transient diabetes insipidus (DI) with classic findings of polyuria, dilute urine, and hypernatremia. We report the case of a 59-year-old male who underwent an emergent bedside cricothyrotomy procedure secondary to papillary carcinoma of the thyroid and subsequently developed septic shock requiring initiation of vasopressin infusion for hemodynamic support. He remained on vasopressin for five days before the infusion was discontinued after clinical improvement. Within 12 hours of vasopressin discontinuation, the patient developed polyuria (> 3 L/day urine output) with volumes as high as 1 L per hour. His serum sodium levels increased more than 10 mmol/L from 137 to 149 mmol/L. This case is unique from prior reports, as our patient was without any neurological or neurosurgical comorbidities that would predispose him to an organic central cause of DI. Furthermore, the patient\'s large-volume diuresis and serum abnormalities spontaneously self-improved within 24 hours without significant medical intervention. In conclusion, this case adds to a growing number of reports of transient DI following vasopressin withdrawal, demonstrating the need to formally recognize this occurrence as a potential consequence of vasopressin use in intensive care settings.
摘要：
血管加压素输注因其血管收缩特性而在晚期血管舒张性休克状态下常用于重症监护。血管加压素还作用于肾脏收集管中的肾小管细胞受体以允许水重吸收。突然停止加压素输注可导致短暂性尿崩症（DI）的发展，并有多尿的经典发现，稀释尿液，和高钠血症.我们报告了一名59岁的男性，该男性因甲状腺乳头状癌继发于紧急床边环膜切开术，随后发生感染性休克，需要开始输注加压素以支持血液动力学。在临床改善后停止输注之前，他继续使用加压素五天。在加压素停药12小时内,患者出现多尿(>3L/天尿量),尿量高达每小时1L.他的血清钠水平从137增加到149mmol/L，超过10mmol/L。这个案例与以前的报道不同，因为我们的患者没有任何神经系统或神经外科合并症，这将使他成为DI的器质性中心原因。此外，患者的大量利尿和血清异常在24小时内自发自我改善，没有显著的药物干预。总之,该病例增加了越来越多的血管加压素停药后的短暂性DI报告，证明有必要正式认识到这种情况是重症监护中使用加压素的潜在后果。
