Kelly Mairead, Verkerk Misha, Harrison Patrick, Oakley Richard
Department of Otolaryngology and Head and Neck Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
Department of Otolaryngology and Head and Neck Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.
BMJ Case Rep. 2021 Apr 9;14(4):e239261. doi: 10.1136/bcr-2020-239261.
Cranial diabetes insipidus (DI), which can cause life-threatening dehydration, is treated with desmopressin, often intranasally. This is challenging in patients whose nasal airflow is altered, such as those requiring tracheostomy. We report the case of a patient, taking intranasal desmopressin for cranial DI, who underwent partial glossectomy, free-flap reconstruction and tracheostomy. Postoperatively, she could not administer nasal desmopressin due to reduced nasal airflow. She developed uncontrollable thirst, polyuria and hypernatraemia. Symptoms were relieved by switching to an enteric formulation. A literature review showed no cases of patients with DI encountering difficulties following tracheostomy. The Royal Society of Endocrinology recommends perioperative planning for such patients, but gives no specific guidance on medication delivery in the context of altered airway anatomy. Careful perioperative planning is required for head and neck patients with DI, particularly for those undergoing airway alteration that may necessitate a change in the mode of delivery of critical medications.
颅咽管瘤性尿崩症（DI）可导致危及生命的脱水，通常采用鼻腔内给予去氨加压素进行治疗。对于鼻腔气流改变的患者，如需要气管切开术的患者，这具有挑战性。我们报告了一例因颅咽管瘤性尿崩症而接受鼻腔内去氨加压素治疗的患者，该患者接受了部分舌切除术、游离皮瓣重建术和气管切开术。术后，由于鼻腔气流减少，她无法给予鼻腔内去氨加压素。她出现了无法控制的口渴、多尿和高钠血症。通过改用肠溶制剂，症状得到缓解。文献综述显示，没有DI患者在气管切开术后遇到困难的病例。英国皇家内分泌学会建议对此类患者进行围手术期规划，但对于气道解剖结构改变情况下的药物给药没有给出具体指导。对于患有DI的头颈患者，特别是那些需要进行气道改变且可能需要改变关键药物给药方式的患者，需要进行仔细的围手术期规划。
