Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Online Case Report
e1246 www.ccmjournal.org December2016•Volume44•Number12
Objective:Todescribeacaseofpartialnephrogenicdiabetesinsipidus
inaburnedpatientafterprolongeddeliveryoflowinspiredconcentra-
tionsofsevofuraneviaanAnestheticConservingDevice.
Data Sources:Clinicalobservation.
Study Selection:Casereport.
Data Extraction:Relevantclinicalinformation.
Data Synthesis:A34-year-oldmanwasadmittedwithburnscov-
ering52%ofhistotalbodysurfacearea.Mechanicalventilation
wasprovidedduringsedationwithcontinuousinfusionsofsufent-
anilandmidazolam.Sedationbecameincreasinglydiffcult,andin
ordertolimitadministrationofIVagents,sevofuranewasadded
to the inspiratory gas fow. This was provided using an Anes-
theticConservingDeviceandcontinuedfor8days.Thepatient
rapidlydevelopedpolyuriaandhypernatremiawithaninappropri-
atedecreaseinurinaryosmolality.Administrationofdesmopres-
sinresultedinonlyamodesteffectonrenalconcentratingability.
After cessation of sevofurane, all variables returned to normal
within5days.Theresultsoffurtherinvestigations(cerebralcom-
putedtomographicscan,cerebralmagneticresonanceimaging,
andserumargininevasopressinconcentration)werecompatible
with a diagnosis of partial nephrogenic diabetes insipidus. The
temporal sequence of clinical fndings in relation to sevofurane
administration suggests that the sevofurane was the probable
underlyingcause.
Conclusions:Cliniciansshouldbeawareofthepossibilityofsevo-
furane-induceddiabetesinsipidusnotonlyduringgeneralanes-
thesiabutalsointheintensivecaresettingofsedationincritically
illpatients.Thisisespeciallyimportantinpatients,suchasthose
withsevereburns,inwhompreservedrenalconcentratingability
is important to ensure compensation for extrarenal fuid losses.
(Crit Care Med2016;44:e1246–e1250)
Key Words: burns; nephrogenic diabetes insipidus; polyuria;
sevofurane
T
here has been increasing interest in the use of sevoflu-
rane for ICU sedation since the introduction in 2005 of
the Anaesthetic Conserving Device (ACD, AnaConDa,
Sedana Medical, Uppsala, Sweden) (1, 2). ACD use with sevo-
flurane seems to be an effective alternative to midazolam or
propofol sedation regimens, allowing for decreased wake-up
and extubation times (3), but data on long-term safety with
the device are currently lacking. Apart from the potential for
inducing malignant hyperthermia and initial fears of nephro-
toxicity, sevoflurane has not been associated with serious side
effects and has enjoyed an excellent safety profile in anesthetic
practice. In particular, renal injury has not been reported in
the ICU setting although plasma inorganic fluoride concentra-
tions exceeding the classic nephrotoxic threshold of 50 μmol/L
initially determined for methoxyflurane have been described
(3, 4). In this case report, we present a patient from our burn
ICU in whom prolonged sevoflurane sedation was associated
with the onset of partial nephrogenic diabetes insipidus (NDI).
CASE PRESENTATION
In January 2015, a healthy 34-year-old Caucasian man (79 kg
and 180 cm) was admitted to our burns centre after jumping
from the second floor of his burning apartment. There was
no significant past medical or surgical history, and he did not
take any regular medicines or illicit drugs and had no known
allergies. At the scene of the incident, the emergency services
intubated his trachea following administration of IV seda-
tion. Beforehand, he was able to move all limbs spontane-
ously and had a documented Glasgow Coma Score of 15/15.
Clinical examination revealed that second- and third-degree
burn wounds distributed over his torso and upper limbs,
with a total body surface area of 52%. Escharotomies of both
upper limbs were later performed in our emergency depart-
ment. There were no signs of smoke inhalation, and arterial
Copyright©2016bytheSocietyofCriticalCareMedicineandWolters
KluwerHealth,Inc.AllRightsReserved.
DOI: 10.1097/CCM.0000000000001956
Allauthors:BurnsUnit,QueenAstridMilitaryHospital,Brussels,Belgium.
Theauthorshavedisclosedthattheydonothaveanypotentialconficts
ofinterest.
Forinformationregardingthisarticle,E-mail:Olivier.Pantet@chuv.ch
Partial Nephrogenic Diabetes Insipidus in a Burned
Patient Receiving Sevoflurane Sedation With an
Anesthetic Conserving Device—A Case Report
Marie Muyldermans, MD; Serge Jennes, MD; Stuart Morrison, MD; Olivier Soete, MD;
Pierre-Michel François, MD; Elkana Keersebilck, MD; Thomas Rose, MD; Olivier Pantet, MD