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Old 09-04-2011
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Urine Sample Increased Urine Output after Pituitary Tumor Resection!

Five hours into a pituitary tumor resection, you notice that the patient has increased urine output. Urine output recorded over the past five hours is: 45ml, 37ml, 210ml, 1500ml and most recently, 2100ml. During the same time period, the patient had received 1000 ml of intravenous crystalloid fluid. Increased urine output in this patient represents:
A. Decreased release of AVP from posterior pituitary
B. Increased diuresis following "third-space" fluid shifts
C. Error in administering lactated ringers fluid rather than normal saline fluid
D. Excessive intravenous administration of crystalloid fluid
E. Inability of kidney to respond to vasopressin
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Old 09-04-2011
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A. Decreased release of AVP from posterior pituitary
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The correct answer is A.
Brain trauma and surgery for pituitary tumors are conditions that predispose to central diabetes insipidus. The inability to synthesize or release AVP (vasopressin) from posterior pituitary results in excessive loss of free water via urine output. By contrast, nephrogenic diabetes insipidus represents an inability of the kidney to respond to available AVP. The treatment for central diabetic insipidus is desmopressin. Both Lactated Ringers and normal saline are crystalloid solutions used for resuscitation and are unrelated to development of diabetes insipidus
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