RESUMEN
OBJECTIVE: To describe a case of partial nephrogenic diabetes insipidus in a burned patient after prolonged delivery of low inspired concentrations of sevoflurane via an Anesthetic Conserving Device. DATA SOURCES: Clinical observation. STUDY SELECTION: Case report. DATA EXTRACTION: Relevant clinical information. DATA SYNTHESIS: A 34-year-old man was admitted with burns covering 52% of his total body surface area. Mechanical ventilation was provided during sedation with continuous infusions of sufentanil and midazolam. Sedation became increasingly difficult, and in order to limit administration of IV agents, sevoflurane was added to the inspiratory gas flow. This was provided using an Anesthetic Conserving Device and continued for 8 days. The patient rapidly developed polyuria and hypernatremia with an inappropriate decrease in urinary osmolality. Administration of desmopressin resulted in only a modest effect on renal concentrating ability. After cessation of sevoflurane, all variables returned to normal within 5 days. The results of further investigations (cerebral computed tomographic scan, cerebral magnetic resonance imaging, and serum arginine vasopressin concentration) were compatible with a diagnosis of partial nephrogenic diabetes insipidus. The temporal sequence of clinical findings in relation to sevoflurane administration suggests that the sevoflurane was the probable underlying cause. CONCLUSIONS: Clinicians should be aware of the possibility of sevoflurane-induced diabetes insipidus not only during general anesthesia but also in the intensive care setting of sedation in critically ill patients. This is especially important in patients, such as those with severe burns, in whom preserved renal concentrating ability is important to ensure compensation for extrarenal fluid losses.
Asunto(s)
Anestésicos por Inhalación/efectos adversos , Quemaduras/terapia , Sedación Consciente/efectos adversos , Nefropatías Diabéticas/inducido químicamente , Éteres Metílicos/efectos adversos , Adulto , Anestésicos por Inhalación/administración & dosificación , Anestésicos por Inhalación/uso terapéutico , Sedación Consciente/instrumentación , Sedación Consciente/métodos , Humanos , Masculino , Éteres Metílicos/administración & dosificación , Éteres Metílicos/uso terapéutico , Respiración Artificial/métodos , SevofluranoAsunto(s)
Lesión Renal Aguda/etiología , Bacteriófagos , Colistina/farmacología , Infecciones por Pseudomonas/tratamiento farmacológico , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Colistina/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa/patogenicidad , Sepsis/complicaciones , Sepsis/tratamiento farmacológicoRESUMEN
BACKGROUND: Peptoniphilus species are Gram-positive anaerobic cocci that are commensals of the human vagina and gut. METHODS AND RESULTS: We describe a case of mixed Escherichia coli and Peptoniphilus spp. osteomyelitis identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry as Peptoniphilus harei and present a short literature review. CONCLUSION: To our knowledge, only six cases of P. harei osteomyelitis have been reported to date.