Post-Surgical Central DI Hypernatraemia — ESENeph MCQ

Correct answer: E — Replace free water and use desmopressin for persistent polyuria

The best answer is “Replace free water and use desmopressin for persistent polyuria”. Cranial diabetes insipidus after pituitary surgery combines absent antidiuretic hormone effect with ongoing hypotonic loss; water deficit, circulation, sodium trajectory and desmopressin timing must be managed together. “Restrict fluid while monitoring sodium and urine concentration” is less appropriate because this worsens the hypernatraemic water deficit “Give tolvaptan to increase renal free-water clearance” is less appropriate because a vasopressin antagonist would worsen cranial diabetes insipidus “Use furosemide while replacing measured urinary water losses” is less appropriate because additional urinary losses can aggravate the deficit “Correct sodium rapidly while monitoring neurological status closely” is less appropriate because overly rapid correction risks cerebral oedema and requires controlled monitoring

Reference: Society for Endocrinology emergency guidance: inpatient cranial diabetes insipidus: https://pmc.ncbi.nlm.nih.gov/articles/PMC6013691/