J Korean Neurosurg Soc.  2005 Dec;38(6):431-434.

Polyuria after Surgery of Ruptured Cerebral Aneurysm: with Special Reference to the Administration of Osmotic Diuretics

Affiliations
  • 1Department of Neurosurgery, School of Medicine, Wonkwang University, Iksan, Korea.

Abstract


OBJECTIVE
Subarachnoid hemorrhage(SAH) is commonly associated with polyuria (solute diuresis or water diuresis). The authors investigate the incidence and clinical characteristics of polyuria with special reference to the administration of osmotic diuretics. METHODS: One hundred and forty eight patients with high urine output (> 200ml/hr) after ruptured cerebral aneurysm operated early from Jan 1998 to Jun 2003 were selected. Water diuresis (diabetes insipidus, DI) was differentiated from solute diuresis by lower urine specific gravity ( < 1.005) and higher plasma osmolality. The incidence and mode of onset of polyuria were compared between two types of diuresis. Additionally, the relationships between development of polyuria and clinical features including aneurysm location, clinical grade, Fisher grade, and outcome were analyzed. Osmotic diuretics were not routinely used in patients with Hunt-Hess grade I-III since July 2001. RESULTS: Annual incidence of polyuria decreased markedly since July 2001: 45.2% in 1998, 34.5% in 2001, 11.9% in 2003. Postoperative DI occurred in 2.4~11.1%. DI developed mainly from ruptured anterior communicating artery aneurysm. The mean interval between the last SAH and the onset of DI was 7.1 days (range 1~27 days) and lasted mean 4.6 days. When compared with solute diuresis, the development of DI was significantly delayed. Other clinical features were not closely related to polyuria. CONCLUSION: Uncontrolled polyuria may lead to cerebral ischemia and electrolyte imbalance because SAH patients are already predisposed to hypovolemia, and will risk precipitating the opposite situation with overhydration. We can decrease the development of polyuria without routine use of osmotic diuretics, by avoiding the increased intracranial pressure such as the intraoperative ventriculostomy and gentle brain retraction in good grade patients.

Keyword

Polyuria; Subarachnoid hemorrhage; Aneurysm; Osmotic diuretics

MeSH Terms

Aneurysm
Brain
Brain Ischemia
Diuresis
Diuretics, Osmotic*
Humans
Hypovolemia
Incidence
Intracranial Aneurysm*
Intracranial Pressure
Osmolar Concentration
Plasma
Polyuria*
Specific Gravity
Subarachnoid Hemorrhage
Ventriculostomy
Water
Diuretics, Osmotic
Water
Full Text Links
  • JKNS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr