Evaluation of a protocol-based treatment strategy for postoperative diabetes insipidus in craniopharyngioma

Ravindran Pratheesh, Diane M A Swallow, Mathew Joseph, Damodaran Natesan, Simon Rajaratnam, K S Jacob, Ari G Chacko

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: Postoperative diabetes insipidus (DI) is a significant cause of morbidity in craniopharyngiomas (CP) and its effective management improves outcome.

OBJECTIVE: The objective was to determine the efficacy of a treatment protocol in the management of early postoperative DI in CP.

MATERIALS AND METHODS: The quality of postoperative DI control in a prospective cohort of 26 patients treated utilizing a strict protocol (Group 1) was compared with a retrospective cohort of 34 patients (Group 2) managed without a protocol. A 6-h urine output more than 4 ml/kg/h or serum sodium (Na+) more than 145 mEq/L was diagnosed as DI. The quality of DI control was assessed by determining the incidence of serum Na+ values above 150 mEq/L or below 130 mEq/L and the incidence of wide (>10 mEq/L) intra-day fluctuations of serum Na+ levels.

RESULTS: The occurrence of high and low serum Na+ levels was significantly lower in Group 1(P = 0.032). The incidence of serum Na+ exceeding 150 mEq/L on postoperative days 2 and 3 was significantly higher in Group 2 as compared with those in Group 1 (25% vs. 7.6%, P = 0.0008). Hyponatremia was more frequent in Group 2 and tended to occur on postoperative days 6, 7, and 8 (14.2% vs. 3.2%; P = 0.004). The same patients who had hypernatremia in the early part of the week later developed hyponatremia. Although the incidence of wide intra-day fluctuations (>10 mEq/L) was higher in Group 2, it did not reach statistical significance.

CONCLUSION: A strict protocol based management results in better control of postoperative DI in CP.

Original languageEnglish
Pages (from-to)712-717
Number of pages6
JournalNeurology India
Volume63
Issue number5
DOIs
Publication statusPublished - 9 Oct 2015

Fingerprint

Craniopharyngioma
Diabetes Insipidus
Clinical Protocols
Serum
Hyponatremia
Incidence
Hypernatremia
Sodium
Urine
Morbidity

Keywords

  • Journal Article
  • Craniopharyngioma
  • diabetes insipidus
  • hypernatremia
  • hyponatremia

Cite this

Evaluation of a protocol-based treatment strategy for postoperative diabetes insipidus in craniopharyngioma. / Pratheesh, Ravindran; Swallow, Diane M A; Joseph, Mathew; Natesan, Damodaran; Rajaratnam, Simon; Jacob, K S; Chacko, Ari G.

In: Neurology India, Vol. 63, No. 5, 09.10.2015, p. 712-717.

Research output: Contribution to journalArticle

Pratheesh, Ravindran ; Swallow, Diane M A ; Joseph, Mathew ; Natesan, Damodaran ; Rajaratnam, Simon ; Jacob, K S ; Chacko, Ari G. / Evaluation of a protocol-based treatment strategy for postoperative diabetes insipidus in craniopharyngioma. In: Neurology India. 2015 ; Vol. 63, No. 5. pp. 712-717.
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AU - Pratheesh, Ravindran

AU - Swallow, Diane M A

AU - Joseph, Mathew

AU - Natesan, Damodaran

AU - Rajaratnam, Simon

AU - Jacob, K S

AU - Chacko, Ari G

PY - 2015/10/9

Y1 - 2015/10/9

N2 - BACKGROUND: Postoperative diabetes insipidus (DI) is a significant cause of morbidity in craniopharyngiomas (CP) and its effective management improves outcome.OBJECTIVE: The objective was to determine the efficacy of a treatment protocol in the management of early postoperative DI in CP.MATERIALS AND METHODS: The quality of postoperative DI control in a prospective cohort of 26 patients treated utilizing a strict protocol (Group 1) was compared with a retrospective cohort of 34 patients (Group 2) managed without a protocol. A 6-h urine output more than 4 ml/kg/h or serum sodium (Na+) more than 145 mEq/L was diagnosed as DI. The quality of DI control was assessed by determining the incidence of serum Na+ values above 150 mEq/L or below 130 mEq/L and the incidence of wide (>10 mEq/L) intra-day fluctuations of serum Na+ levels.RESULTS: The occurrence of high and low serum Na+ levels was significantly lower in Group 1(P = 0.032). The incidence of serum Na+ exceeding 150 mEq/L on postoperative days 2 and 3 was significantly higher in Group 2 as compared with those in Group 1 (25% vs. 7.6%, P = 0.0008). Hyponatremia was more frequent in Group 2 and tended to occur on postoperative days 6, 7, and 8 (14.2% vs. 3.2%; P = 0.004). The same patients who had hypernatremia in the early part of the week later developed hyponatremia. Although the incidence of wide intra-day fluctuations (>10 mEq/L) was higher in Group 2, it did not reach statistical significance.CONCLUSION: A strict protocol based management results in better control of postoperative DI in CP.

AB - BACKGROUND: Postoperative diabetes insipidus (DI) is a significant cause of morbidity in craniopharyngiomas (CP) and its effective management improves outcome.OBJECTIVE: The objective was to determine the efficacy of a treatment protocol in the management of early postoperative DI in CP.MATERIALS AND METHODS: The quality of postoperative DI control in a prospective cohort of 26 patients treated utilizing a strict protocol (Group 1) was compared with a retrospective cohort of 34 patients (Group 2) managed without a protocol. A 6-h urine output more than 4 ml/kg/h or serum sodium (Na+) more than 145 mEq/L was diagnosed as DI. The quality of DI control was assessed by determining the incidence of serum Na+ values above 150 mEq/L or below 130 mEq/L and the incidence of wide (>10 mEq/L) intra-day fluctuations of serum Na+ levels.RESULTS: The occurrence of high and low serum Na+ levels was significantly lower in Group 1(P = 0.032). The incidence of serum Na+ exceeding 150 mEq/L on postoperative days 2 and 3 was significantly higher in Group 2 as compared with those in Group 1 (25% vs. 7.6%, P = 0.0008). Hyponatremia was more frequent in Group 2 and tended to occur on postoperative days 6, 7, and 8 (14.2% vs. 3.2%; P = 0.004). The same patients who had hypernatremia in the early part of the week later developed hyponatremia. Although the incidence of wide intra-day fluctuations (>10 mEq/L) was higher in Group 2, it did not reach statistical significance.CONCLUSION: A strict protocol based management results in better control of postoperative DI in CP.

KW - Journal Article

KW - Craniopharyngioma

KW - diabetes insipidus

KW - hypernatremia

KW - hyponatremia

U2 - 10.4103/0028-3886.166533

DO - 10.4103/0028-3886.166533

M3 - Article

VL - 63

SP - 712

EP - 717

JO - Neurology India

JF - Neurology India

SN - 0028-3886

IS - 5

ER -