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

Kang, Sung-Don,Kim, Jong-Moon The Korean Neurosurgical Society 2005 Journal of Korean neurosurgical society Vol.38 No.6

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 $2.4{\sim}11.1%$. 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 $1{\sim}27$ 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.

The Relations between Enuresis in Childhood and Nocturnal Polyuria Syndrome in Adult Life

Halil Ciftci,Murat Savas,Adem Altunkol,Halil Öncel,ErcanYeni,AyhanVerit 대한배뇨장애요실금학회 2012 International Neurourology Journal Vol.16 No.1

Purpose: The aim of this study, to investigate whether there is any association between enuresis in childhood and nocturnal polyuria syndrome (NPS) in adult life. Methods: The study consisted of thirty five patients with nocturnal polyuria, and thirty five healthy people without nocturnal polyuria in adult life, were asked to assess their enuresis in childhood. Results: There was a history of enuresis in childhood in 18 (51.42%) of 35 of men with nocturnal polyuria and in 4 (11.42%) of 35 without nocturnal polyuria. Enuresis in childhood was significantly more common in men with nocturnal polyuria than without nocturnal polyuria. The difference was significant (P<0.0001). The prevalence of enuresis in the nocturnal polyuria (51.42%) was more than two-fold higher than reported prevalence in general populations. Conclusions: The results of this study suggest that the history of enuresis in childhood seems to increase the risk of having NPS in adult life. This relationship should be taken into account in the evaluation of men with complaints from NPS in adult life and the possible common pathophysiology should be considered in the treatment planning.

중환자에서 발견되는 저혈압을 동반한 원인 불명의 다뇨와 나트륨뇨

천광진 ( Kwang Jin Chun ),이동규 ( Dong Kyu Lee ),백현정 ( Hyun Jung Baek ),김상욱 ( Sang Wook Kim ),정해혁 ( Hae Hyuk Jung ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6

Purpose: We observed excessive renal excretion of salt and water, without underlying renal diseases or definite causes, accompanied with severe hypotension in critically ill patients. This study investigates the clinical courses and characteristics of these patients. Methods: We retrospectively analyzed 13 patients with polyuria of unknown origin, which persited equal to or longer than 3 days, among hypotensive patients, who were admitted to intensive care unit. Results: The causes of hypotension included sepsis in 11 patients and adrenal insufficiceny in one patient. The cause of hyptension was unknown in one patient. Vassopressors were used in all patients, and hypotension persisted for 13.2±8.6 days. Polyuria persisted for 10.6±8.2 days, and the duration of polyuria was strongly correlated with that of hypotension (R=0.919, p<0.001). Low dose steroid was used in 8 patients for the treatment of hypotension, and hypotension improved in 3 patients within 2 days after steroid administration. Four patients died during the hosptialization, and the duration of hypotension in non-survivors was greater than that in survivors (21.2±9.7 days and 9.6±5.2 days respectively, p=0.020). Conclusion: In critically ill patients with severe hypotension, we observed 13 cases of inappropriate natriuresis and polyuria. These results suggest that the persistence of poyluria and hypotension might affect the prognosis of these patients, and adrenal insufficicieny might be associated with this appearance in some patients. Further studies are needed to establish causes and treatments for this appearance.

The Prevalence of Nocturia and Nocturnal Polyuria: Can New Cutoff Values Be Suggested According to Age and Sex?

Ali Ersin Zumrutbas,Ali Ihsan Bozkurt,Okan Alkis,Cihan Toktas,Bulent Cetinel,Zafer Aybek 대한배뇨장애요실금학회 2016 International Neurourology Journal Vol.20 No.4

Purpose: The aims of this study were to assess the prevalence of nocturia and nocturnal polyuria (NP) and to define new cutoff values according to age and sex for both conditions. Methods: Data from a population-based prevalence survey conducted among a random sample of 2,128 adults were analyzed in this study. Participants were requested to fill out a questionnaire including the International Continence Society (ICS) definitions of lower urinary tract symptoms and the International Consultation on Incontinence Questionnaire - Short Form. Additionally, a 1-day bladder diary was given to each individual. The participants were divided into 5 age groups. The prevalence of nocturia was calculated based on definitions of nocturia as ≥1 voiding episodes, ≥2 episodes, and ≥3 episodes. NP was evaluated according to the ICS definition. The mean±standard errors and 95th percentile values were calculated in each group as new cutoff values for NP. Results: The prevalence of nocturia was estimated as 28.4%, 17.6%, and 8.9% for ≥1, ≥2, and ≥3 voiding episodes each night, respectively. When nocturia was defined as 2 or more voiding episodes at night, the prevalence decreased significantly. The mean NP index was 29.4%±15.0% in men and 23.1%±11.8% in women. For the age groups of <50 years, 50–59 years, and ≥60 years, the new cutoff values for the diagnosis of NP were calculated as 48%, 69%, and 59% for men and 41%, 50%, and 42% for women, respectively. Conclusions: We found that the definition of nocturia was still controversial and that waking up once for voiding might be within the normal spectrum of behavior. The definition of NP should be modified, and new cutoff values should be defined using the data presented in our study and in other forthcoming studies.

Tachycardia-polyuria syndrome after swan-ganz catheterization in liver transplant patient - A case report -

Heo Sang-Kwon,Kim Kyoung-Sun,Lee Jeong-Hyun,송준걸 대한마취통증의학회 2021 Anesthesia and pain medicine Vol.16 No.3

Background: Tachycardia-polyuria syndrome is characterized by polyuria occurring because of tachycardia with a heart rate of ≥ 120 beats/min lasting ≥ 30 min. We report such a case occurring after swan-ganz catheterization.Case: A 41-year-old male was scheduled for living-donor liver transplantation. After general anesthesia, atrial fibrillation occurred during swan-ganz catheterization, and polyuria developed 1 h later. During the anhepatic phase, the patient’s heart rate increased further, and cardioversion was performed. After a normal sinus rhythm was achieved, the patient’s urine output returned to normal.Conclusions: The patient’s polyuria seemed related to the iatrogenic atrial fibrillation occurring during swan-ganz catheterization. Although we did not measure atrial natriuretic peptide, an increase in its concentration may have been the main mechanism of polyuria, as natriuresis was observed.

경수손상환자에서 항이뇨 호르몬의 일과성 변동과 야간 다뇨증의 연관성

강대수,이언석,한명석,권호중,박동식 大韓再活醫學會 1999 Annals of Rehabilitation Medicine Vol.23 No.4

Hypokalemia-induced Polyuria with Nocturia after Intravenous Methylprednisolone Pulse Therapy in a Henoch-Schönlein Purpura Nephritis Patient

이준호,김근정 대한소아신장학회 2010 Childhood kidney diseases Vol.14 No.2

Patients with moderate to severe degrees of Henoch-Schönlein purpura (HSP) nephritis receive high-dose intravenous methylprednisolone pulse therapy (IMPT). Although the regimen is generally safe and effective, various complications occasionally develop. administration of excessive corticosteroid can induce urinary potassium wasting leading to hypokalemia. Polyuria, one of the complications of hypokalemia, is related to both increased thirst and mild nephrogenic diabetes insipidus. And hypokalemia itself also impairs the maximal renal urinary concentration ability. Although polyuria or nocturia after IMPT is not common, it is correctable immediately by oral potassium supplementation. Therefore, during IMPT, careful history taking of nocturia as well as monitoring urine volume, serum and urine potassium level at regular follow-up are necessary because even mild hypokalemia can provoke urine concentrating ability defect. We experienced a case of 11 year-old boy with HSP nephritis who suffered from hypokalemia- induced polyuria with nocturia right after IMPT.

Hypokalemia-induced Polyuria with Nocturia after Intravenous Methylprednisolone Pulse Therapy in a Henoch-Sch$\ddot{o}$nlein Purpura Nephritis Patient

김근정,이준호,Kim, Geun-Jung,Lee, Jun-Ho Korean Society of Pediatric Nephrology 2010 Childhood kidney diseases Vol.14 No.2

경정맥 고용량 스테로이드 충격요법(IMPT)의 부작용으로는 고혈압, 동성 서맥, 심방심실 전도장애, 심방 세동, 심방 조동, 심실 빈맥 등의 부정맥, 구토, 구역질 등의 소화기 장애, 백내장, 저칼륨혈증, 그리고 감염성 질환 등이 있다. 그중, 저칼륨혈증은 IMPT를 받는 환자의 17% 정도에서 경미하게 나타날 수 있다. 저칼륨혈증이 신수질의 요농축 능력을 저하시켜 다뇨가 발생할 수 있다는 사실은 이미 알려져 있지만, IMPT후 경미한 저칼륨혈증으로 인해 심한 야간뇨과 다뇨증이 발생하였다는 보고는 별로 없다. 이에 본 저자들은 다량의 단백뇨와 혈뇨를 보이는 HSP 신염환자에게 세 차례의 IMPT 시행 후 환아에게 발생한 경미한 저칼륨혈증으로 인한 심한 야간뇨와 다뇨증의 발생을 경험하였기에 이에 보고하는 바이다. Patients with moderate to severe degrees of Henoch-Sch$\ddot{o}$nlein purpura (HSP) nephritis receive high-dose intravenous methylprednisolone pulse therapy (IMPT). Although the regimen is generally safe and effective, various complications occasionally develop. administration of excessive corticosteroid can induce urinary potassium wasting leading to hypokalemia. Polyuria, one of the complications of hypokalemia, is related to both increased thirst and mild nephrogenic diabetes insipidus. And hypokalemia itself also impairs the maximal renal urinary concentration ability. Although polyuria or nocturia after IMPT is not common, it is correctable immediately by oral potassium supplementation. Therefore, during IMPT, careful history taking of nocturia as well as monitoring urine volume, serum and urine potassium level at regular follow-up are necessary because even mild hypokalemia can provoke urine concentrating ability defect. We experienced a case of 11 year-old boy with HSP nephritis who suffered from hypokalemia-induced polyuria with nocturia right after IMPT.

Nocturnal Urine Production in Women With Global Polyuria

Thomas F. Monaghan,Adriana M. Kavoussi,Christina W. Agudelo,Syed N. Rahman,Kyle P. Michelson,Donald L. Bliwise,Jason M. Lazar,Lori A. Birder,Upeksha S. Alwis,Johan Vande Walle,Alan J. Wein,Jerry G. Bl 대한배뇨장애요실금학회 2020 International Neurourology Journal Vol.24 No.3

Purpose: Low nocturnal urine production (NUP) may be sufficient to rule out global polyuria (GP) in men. This study determines the sensitivity of indices for nocturnal polyuria (NP), defined as nocturnal polyuria index (NPi; nocturnal urine volume/24-hour urine volume) ≥0.33 or NUP ≥90 mL/hr, for detecting GP in women. Methods: Data were analyzed from 2 prospective protocols involving subjects recruited from a urology ambulatory care unit and a continence clinic. Women ≥18 years with nocturia were included if they met either of 2 common criteria for GP: (1) ≥40 mL/kg/24 hr or (2) ≥3,000 mL/24 hr. Results: Thirty-one women were included (NPi, 28.6 [21.3–40.7]; NUP, 100.8 [68.3–135.8] mL/hr). At the ≥40 mL/kg/24-hr cutoff, 40% and 63% of women reporting ≥1 nocturnal void(s) (n=30) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. Additionally, 53% and 71% of subjects reporting ≥2 nocturnal voids (n=17) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. At the ≥3,000 mL/24-hr cutoff, 38% and 69% of women reporting ≥1 nocturnal void(s) (n=13) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively, and 63% and 88% of subjects reporting ≥2 nocturnal voids (n=8) had NPi ≥0.33 and NUP ≥90 mL/hr, respectively. By extension, 37%–62% of women with nocturia and GP did not have NP by NPi ≥0.33 criteria, and 12%–37% did not have NP by NUP ≥90 mL/hr criteria. Conclusions: Indices of excess nighttime urination do not reliably predict GP in women. A full-length voiding diary may be particularly important in the evaluation of women with nocturia. Nocturia in women merits further consideration as a distinct entity.

Case Report : Polyuria with the Concurrent manifestation of Central Diabetes Insipidus (CDI) & Type 2 Diabetes Mellitus (DM)

( Hyun Jong Shin ),( Jae Ha Kim ),( Joo Hark Yi ),( Sang Woong Han ),( Ho Jung Kim ) 대한전해질학회 2012 Electrolytes & Blood Pressure Vol.10 No.1

We report a rare case of the concurrent manifestation of central diabetes insipidus (CDI) and type 2 diabetes mellitus (DM). A 56 year-old man was diagnosed as a type 2 DM on the basis of hyperglycemia with polyuria and polydipsia at a local clinic two months ago and started an oral hypoglycemic medication, but resulted in no symptomatic improvement at all. Upon admission to the university hospital, the patient`s initial fasting blood sugar level was 140mg/dL, and he showed polydipsic and polyuric conditions more than 8 L urine/day. Despite the hyperglycemia controlled with metformin and diet, his symptoms persisted. Further investigations including water deprivation test confirmed the coexisting CDI of unknown origin, and the patient`s symptoms including an intense thirst were markedly improved by desmopressin nasal spray (10 μg/day). The possibility of a common origin of CDI and type 2 DM is raised in a review of the few relevant adult cases in the literature.