| Studies on Post-operative Water and Electrolyte Disturbances in Patients with Craniopharyngioma
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Se Mo Suh |
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Department of Pediatrics Yonsei University College of Medicine Seoul, Korea |
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| Abstract |
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1)In 4 of the 5 patients with transient hypernatremia, the development of hypernatremia was associated with a loss of water and body weight, as the result of decreased ADH output and of a transient disturbance in water intake, either due to disturbed thirst or inadequate supply of water. The 5th patient developed a transient hypernatremia, not associated with the water loss but with water retention and weight gain and an inappropriate secretion of aldosterone. 2)3 patients developed transient hyponatremia which was associated with water retention and weight, gain,as the result of an inappropriate ADH secretion. 3) In 3 patients who had developed transient hyper & hyponatremia, the development of hypernatremia was associated with loss of water as the result of decreased ADH output and inadequate water intake. The hyponatremia was associated with water retention, as the result of an inappropriate ADH secretion. 4)In 2 of 4 patients with chronic hypernatremia, the development of hypernatremia was associated with loss of water and body weight due to decreased ADH output and inadequate water intake. The chronic state of hypernatremia seemed to be maintained due to a combination of decreased ADH activity and a persistant loss of thirst. In the other 2 patients, the developement of hyper-natremia was associated with a transient, inappropriate secretion of aldosterone in the early post operative period. Subsequently, the aldosterone activity returned to normal, but the state of hypernatremia persisted despite low Na intake, high K intake, or chronic water loading, suggesting the w resetting of osmoreceptors” to a higher threshold. 5)Determinations of other electrolytes showed no
significant disturbances except for the serum Cl, which showed pattern of changes similar to those of the
serum Na values. 6)In all patients, there was a disturbance in the ADH output postoperatively, either a transient or persistant loss of ADH. As judged by the specific gravity of the hourly voided urine, the loss of ADH
was never complete in any single day, even with a large volume of urine. 7) In 4 patients, who underwent acute water loading test, all showed impaired ability to excrete the excess water and this was not corrected by use of
cortisone or thyroid medication. Impaired renal function and dehydration seemed to play an important
role in this disturbed water excretion. A possible role of decreased secretion of growth hormone was also
discussed. 8) No significant correlation can be established between the above mentioned electrolyte disturbances, the pre- & post-operative clinical findings, and renal & endocrine functions, except that, in 4 cases showing a hypothalamic lesion at the time of the surgery, all developed chronic hypernatremia along with the clinical signs of hypothalamic damage, such as loss of thirst, fluctuation in vital signs, personality changes
and obesity. |
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