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.

SIADH, adult, aldosterone, article, brain surgery, case report, chemical analysis, desmopressin, diabetes insipidus, disease, female, fluid balance, gait disorder, human, hydrocortisone, hypernatraemia, hypernatremia, hyponatraemia, hyponatremia, inappropriate vasopressin secretion, infusion fluid, meningioma, metyrapone, neurosurgery, nuclear magnetic resonance imaging, pathophysiology, polyuria, postoperative complication, priority journal, relative density, renin, severity, sodium, sodium blood level, sodium chloride, urine osmolality, vasopressin
dx.doi.org/10.1093/ndtplus/sfp117, hdl.handle.net/1765/21230
N D T Plus
Erasmus MC: University Medical Center Rotterdam

Hoorn, E.J, & Zietse, R. (2010). Water balance disorders after neurosurgery: The triphasic response revisited. N D T Plus, 3(1), 42–44. doi:10.1093/ndtplus/sfp117