Citation

Keyal NK, Bhujel A. J. Crit. Care Med. (Targu Mures) 2019; 5(4): 145-148.

Affiliation

Department of Critical Care Medicine, B & C Medical College and Teaching Hospital and Research Center, Birtamode, Nepal.

Copyright

(Copyright © 2019, Universitatea de Medicină și Farmacie Tîrgu-Mures, Publisher Walter de Gruyter)

DOI

10.2478/jccm-2019-0023

PMID

31915721

PMCID

PMC6942452

Abstract

INTRODUCTION: Organophosphorus poisoning is the most common poison used for suicidal attempt in Nepal. Diabetes insipidus is unusual and rare in this poisoning. This is the second case report of Diabetes insipidus developing in organophosphorus poisoning. Management of diabetes insipidus includes desmopressin and adequate fluid management. CASE PRESENTATION: A 34-year-old female patient accompanied by her father presented at the Emergency department with an alleged history of ingestion of unknown amount of chlorpyrifos, cypermethrin and quinalphos. On admission, she had a Glasgow Coma Scale (GCS) of 7/15. Her blood pressure was 110/60 mm Hg, pulse 54/min, respiratory rate 45/min and saturation 35% on room air, pinpoint pupil reactive to light and bilateral crepitations. She was immediately resuscitated with two litres of normal saline and intubated with a 7 mm endotracheal tube. Atropinisation was done, and pralidoxime was started. She developed a urine output of 250-350 ml per hour with rising sodium and serum osmolality. The urine examination showed low sodium and urine specific gravity. A diagnosis of diabetes insipidus was made. There was no immediate improvement in her GCS. She was managed with 5% dextrose and subcutaneous desmopressin and was transferred out of the intensive care unit on the sixth day and was discharged from hospital on the fifteenth day.

CONCLUSION: Diabetes insipidus is a rare transient complication in organophosphorus poisoning that requires careful observation and early management with desmopressin and adequate fluid balance to improve patient outcome.

© 2019 Niraj Kumar Keyal, Amid Bhujel, published by Sciendo.

Language: en

Keywords

desmopressin; diabetes insipidus; organophosphorus; urine