Postoperative diabetes insipidus: how to define and grade this complication?

Purpose Although transient diabetes insipidus (DI) is the most common complication of pituitary surgery, there is no consensus on its definition. Polyuria is the most overt symptoms of DI, but can also reflect several physiological adaptive mechanisms in the postoperative phase. These may be difficult to distinguish from and might coincide with DI. The difficulty to distinguish DI from other causes of postoperative polyuria might explain the high variation in incidence rates. This limits interpretation of outcomes, in particular complication rates between centers, and may lead to unnecessary treatment. Aim of this review is to determine a pathophysiologically sound and practical definition of DI for uniform outcome evaluations and treatment recommendations. Methods This study incorporates actual data and the experience of our center and combines this with a review of literature on pathophysiological mechanisms and definitions used in clinical studies reporting of postoperative DI. Results The occurrence of excessive thirst and/or hyperosmolality or hypernatremia are the best indicators to discriminate between pathophysiological symptoms and signs of DI and other causes. Urine osmolality distinguishes DI from osmotic diuresis. Conclusions To improve reliability and comparability we propose the following definition for postoperative DI: polyuria (urine production > 300 ml/hour for 3 h) accompanied by a urine specific gravity (USG) < 1.005, and at least one of the following symptoms: excessive thirst, serum osmolality > 300 mosmol/kg, or serum sodium > 145 mmol/L. To prevent unnecessary treatment with desmopressin, we present an algorithm for the diagnosis and treatment of postoperative DI.

Psychogenic polydipsia: A case report

IntroductionPsychogenic or primary polydipsia characterized by excessive thirst and compulsive water drinking is a common problem among psychiatric populations, affecting 6% to 20% of patients. It is frequent in chronic psychiatric diseases, particularly schizophrenia. We report a patient with excessive thirst and diagnosed as PIP syndrome.CaseA 54-year-old, married, female patient had normal vital signs. She has excessive water intake (10–12 L/day). She did not have edema, signs of dehydration or fever. The neurological examination, CT, MRI, and EEG was normal. The laboratory tests were normal. She had started using sertraline 100 mg, 7 months ago due to anxiety disorder. There is not any disease except the anxiety disorder, which is in remission due to the treatment. A total of, 2 μg desmopressin I.M. is applied in fluid restriction test. The urine density is determined as 1.008 mg/dL initially, 1.011 mg/dL one hour later, and 1.013 mg/dL two hours later in the urinary test. The diagnosis is psychogenic polydipsia (primary) according to patient history, the clinical examination, and the test results. The patient is recommended to continue the sertraline 100 mg treatment, and also assigned with fluid restriction behaviour.ConclusionSince excess water intake periods are correlated with psychotic exacerbations; psychosis and polydipsia might have similar physiopathologic mechanisms. Polydipsia might be due to anti-cholinergic side effect of some psychiatric drugs. The physiopathology of the polydipsia and polyuria is not totally enlightened in the psychiatric disorders. In some cases, the fluid intake occurs completely voluntary. Therefore, we decided to present this case.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Assessment of Fluoride Content in Ground and Surface Water and its Environmental Impacts at Basavan-Bagewadi and Muddebihal Taluka of Bijapur District, Karnataka, India

An investigation was undertaken in 10 villages (28 samples) of Basavan-Bagewadi taluka and 11 villages (38 samples) of Muddebihal taluka of Bijapur district to assess fluoride and other physicochemical parameters. And also to assess the clinical symptoms like dental and skeletal fluorosis, joint pains and gastrointestinal diseases and to find out the severity of the disease. A check list developed with the help of available literature and in consolation with nutritionists was used to record clinical symptoms. A sample survey was made after examination for both sexes between the age of 8-50 years at Basavan-Bagewadi and Muddebihal taluka. Fluoride content varies from 0.40-6.40 mg/L and 1.10-7.10 mg/L. However 12 samples were within the range, while 16 samples were above the permissible limits at Basavan-Bagewadi Taluka where as in Muddebihal taluka all the values are above the permissible limits of WHO respectively. The results show that, out of the 2992 examined 824 (25.89%) people have dental and skeletal fluorosis, 274 (9.15%) people have joint pains, 167 (5.58%) have gastrointestinal discomfort and excessive thirst at different stages in Basavan-Bagewadi taluka. Among 2696 examined, 812(29.49%) people had dental and skeletal fluorosis, 432 (16.18%) people had joint pains, 415 (15.54%) people had gastrointestinal discomfort and excessive thirst at Muddebihal taluka of Bijapur district.