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Polyuria: case report A 68-year-old man developed polyuria during treatment with dexmedetomidine to prevent disruptive behavior and propofol for induction of anaesthesia. The man, who had schizophrenia, was diagnosed with superficial lobe parotid gland tumor. A superficial parotidectomy was planned. On admission, he displayed violent behavior and experienced persecutory delusions. On the day of surgery, anaesthetic premedication included roxatidine and diazepam. Anaesthesia was induced with propofol 80mg along with remifentanil. Anaesthesia was maintained with continuous infusions of propofol (3–5mg kg-1 hour-1) and remifentanil. Suxamethonium-chloride [succinylcholine] was administered to facilitate endotracheal intubation. Additionally, he was receiving various concomitant medications. He was uneventfully extubated. Following admission to the ICU, a continuous IV dexmedetomidine infusion 0.4 µg kg-1 hour-1 was prophylactically started without a loading dose to prevent disruptive behavior. Two hours following the start of the dexmedetomidine infusion, his urine output increased from a baseline rate of 80 mL/h to a 7-hour average rate of 400 mL/h. Increase in urine output was associated with an increase in serum sodium concentration from 132 to 139 mEq/L. A urine-specific gravity of 1.006 was noted, documenting dilution of urine. The man was administered with IV maintenance fluid. During this time period, his blood glucose concentration and haemodynamic and neurological vital signs remained normal. The partial pressure of arterial carbon dioxide (PaCO2) concentration increased to 56mm Hg. At this time, dexmedetomidine infusion was discontinued. After one hour, the urine output decreased to an average of 66 mL/h. By the next morning, the serum sodium concentration also decreased to 136 mEq/L, while urine specific gravity increased to 1.013. His general condition remained unremarkable. Hence, he was transferred to the general ward on the same day. Subsequent postoperative course was uneventful. On postoperative day 9, he was discharged. Takekawa D, et al. Postoperative Dexmedetomidine-Induced Polyuria in a Patient With Schizophrenia: A Case Report. A and A Practice 14: 131-133, No. 5, Mar 2020. 803514549 Available from: URL: http://doi.org/10.1213/XAA.0000000000001162

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Reactions 14 Nov 2020 No. 1830