Perioperative Infusion Management for Adhesive Bowel Obstruction with Congenital Nephrogenic Diabetes Insipidus: A Case Report

Abstract

Congenital nephrogenic diabetes insipidus (CNDI) is a rare disease that results in polyuria due to decreased responsiveness to the antidiuretic hormone in the collecting ducts of the kidney. Without compensation by drinking large amounts of water, dehydration and hypernatremia can rapidly develop. We present a case of a patient originally diagnosed with CNDI who required surgery and a fasting period due to adhesive bowel obstruction. The patient was a 46-year-old man who was originally diagnosed with CNDI. He was prescribed trichlormethiazide but self-discontinued treatment in the process. His normal urine output was about 7,000-8,000 mL/day. He underwent robot-assisted radical cystectomy and uretero-cutaneostomy for bladder cancer. Two years later, he was hospitalized due to adhesive bowel obstruction. A 5% glucose solution was infused, and the dose was adjusted according to the urine volume and electrolytes. An adhesiotomy was performed due to recurrent bowel obstruction in a short period of time. A 5% glucose solution was used as the main infusion during the perioperative period. Once drinking water was resumed after surgery, urinary output and electrolytes were easily controlled. In conclusion, patients with CNDI should be given a 5% glucose solution as the primary infusion, and the infusion volume should be adjusted by monitoring daily urine output, electrolytes, and blood glucose levels. Infusion management is easier if oral intake is initiated as early as possible.

Keywords: diabetes insipidus; infusions; intravenous; nephrogenic; perioperative period.

Fig. 1.

Computed tomography findings at the time of consultation. Computed tomography showed bowel dilatation and caliber changes in the pelvic floor (red arrow), with no closed loop.

Fig. 2.

Treatment progress and fluid IN/OUT balance. The solid line represents the total water supply, and the dotted line represents the infusion volume. The difference between the solid and dotted lines is the drinking water volume. The solid bar represents urine volume, and the shaded bar represents the amount of fluid drained from the nasogastric tube (NG tube). All units are in “mL”.

Fig. 3.

Transition of urine volume and serum sodium. Bars and lines indicate the daily volume of urine output (mL) and serum sodium (mmol/L).