A 45-year-old man presents 2 weeks after transsphenoidal pituitary surgery with polyuria (6 L/day) and polydipsia. Vital signs show HR 88/min, BP 128/82 mmHg, RR 16/min. Labs reveal serum osmolality 305 mOsm/kg, serum sodium 148 mEq/L, and urine osmolality 180 mOsm/kg. Urine specific gravity is 1.005. He denies recent diuretic use. Which medication is most appropriate?

  1. A)Hypertonic saline infusion
  2. B)Free water loading
  3. C)Desmopressin (DDAVP) replacementGABARITO
  4. D)Fluid restriction to 1 L/day
  5. E)Thiazide diuretic

Explicação

Central diabetes insipidus caused by ADH deficiency is common after pituitary surgery. The high serum osmolality with inappropriately dilute urine (osmolality <200 mOsm/kg) confirms the diagnosis. DDAVP replacement is the appropriate treatment. Ver explicação completa e trilha adaptativa →

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