Abstract
We report a case of hypotonic hyponatremia, presumably due to desmopressin administration, during a dental treatment under a general anesthesia of a patient who was suffered from diabetes insipidus and mental retardation.
The patient, 11-year-old male, received an operative removal of cranio pharygioma at the age of 5 and because of secondary diabetes insipidus, he had been treated with desmopressin thereafter.
After the regular administration of desmopressin nose drop in the morning, we gave him gengeral anesthesia, and hypotonic hyponatremia presumably desmopressin-induced, was seen during the opration, although it was not severe. To prevent this side effect of desmopressin, preoperative evaluation of intake and output balance of water, serum osmotic pressure, serum electrolytes and diurnal variation of these values if possible, must be important. In this case, however, mental retardation and difficult venipuncture due to the serious degree of obesity made us to obtain these data only at one point of the day, and the venipuncture time might be unsuitable. Consequently, for the prevention of perioperative side effects of desmopressin, preoperative evaluation should be examined under the similar conditions with those of the operation day, namely water balance under fasting, time of desmopressin administration, and venipunctueres considering the period of anesthetic management for the operation.
