Manajemen Diabetes Insipidus pada Pasien Meningioma Pascakraniotomi Pengangkatan Tumor di Ruang Rawat Intensif

Surgery in the hypothalamic area is often accompanied by disturbances of water, electrolytes, and osmoregulation due to manipulation and vascular changes of the neurohypophysis. Over the last few decades, surgical approaches to craniopharyngioma have been developed. Initially, tumor resection was the treatment of choice but now evolved to minimally invasive surgery such as transphenoidal surgery. We reported a 58 years old female patient with suprasellar meningioma underwent removal tumor craniotomy. Patient was ASA 2 physical status with controlled Diabetes Mellitus type 2 non-obese. The operation was smooth and hemodynamically stable during surgery. Patient underwent post-surgery treatment in the ICU. During monitoring in the ICU, urin output of the patient was more than >2 cc/kgBB/hour. From the results of investigations, patient was diagnosed with Diabetes Insipidus. During the 6 days of ICU care, periodic examination of serum and urin electrolytes and periodic fluid balances for monitoring, as well as the use of vasopressin as a management of Diabetes Insipidus were conducted periodically. The patient improved after treatment for 6 days in the ICU, with urin output and electrolytes returning to normal without vasopressin.

Pembedahan di area hipotalamus sering disertai gangguan regulasi air, elektrolit, dan osmoregulation akibat manipulasi dan perubahan vaskular dari neurohipofisis. Selama beberapa dekade terakhir telah berkembang pendekatan bedah pada kasus craniopharingioma. Pada awalnya, reseksi tumor adalah pilihan terapi namun kini sudah berkembang ke minimal invasive surgery seperti transphenoidal surgery. Dilaporkan pasien perempuan, 58 tahun dengan meningioma suprasellar menjalani operasi kraniotomi pengangkatan tumor. Pasien status fisik ASA 2 dengan diabetes mellitus tipe 2 non-obese terkontrol. Operasi berjalan lancar dengan hemodinamik stabil selama operasi. Pascaoperasi pasien menjalani perawatan di ICU. Saat pengawasan di ICU, didapatkan urin output pasien lebih dari 2 cc/kgBB/jam. Dari hasil pemeriksaan penunjang, pasien didiagnosis dengan diabetes insipidus. Selama 6 hari perawatan di ICU, dilakukan pemeriksaan berkala elektrolit serum dan urin serta balans cairan berkala untuk pemantauan, serta penggunaan vasopressin sebagai tatalaksana diabetes insipidus. Pasien membaik setelah perawatan selama 6 hari di ICU, dengan urin output dan elektrolit kembali normal tanpa vasopressin.