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Perioperative management of cranial diabetes insipidus in a patient requiring a tracheostomy
  1. Mairead Kelly,
  2. Misha Verkerk,
  3. Patrick Harrison and
  4. Richard Oakley
  1. Department of Otolaryngology and Head and Neck Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr Mairead Kelly; maireadchristinekelly{at}gmail.com

Abstract

Cranial diabetes insipidus (DI), which can cause life-threatening dehydration, is treated with desmopressin, often intranasally. This is challenging in patients whose nasal airflow is altered, such as those requiring tracheostomy. We report the case of a patient, taking intranasal desmopressin for cranial DI, who underwent partial glossectomy, free-flap reconstruction and tracheostomy. Postoperatively, she could not administer nasal desmopressin due to reduced nasal airflow. She developed uncontrollable thirst, polyuria and hypernatraemia. Symptoms were relieved by switching to an enteric formulation. A literature review showed no cases of patients with DI encountering difficulties following tracheostomy. The Royal Society of Endocrinology recommends perioperative planning for such patients, but gives no specific guidance on medication delivery in the context of altered airway anatomy. Careful perioperative planning is required for head and neck patients with DI, particularly for those undergoing airway alteration that may necessitate a change in the mode of delivery of critical medications.

  • drugs and medicines
  • endocrinology
  • head and neck cancer
  • head and neck surgery
  • drug therapy related to surgery

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Footnotes

  • Contributors RO and MV were responsible for the original concept of the paper and for commenting extensively on drafts. MV was responsible for liaising with endocrinology colleagues and also wrote the bullet point summary. MK wrote the original draft of the Abstract, Case report, Discussion and Conclusions sections and liaised with the patient for the Patient’s perspective. PH conducted the literature review and wrote the original draft of the Introduction.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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