Dexmedetomidine-associated polyuria mimicking diabetes insipidus

Authors

• Sankalp Acharya Department of Internal Medicine, Rutgers Monmouth Medical Center, Long Branch, USA
• Sai Shahane Department of Internal Medicine, Rutgers Monmouth Medical Center, Long Branch, USA
• Sanket Patel Department of Internal Medicine, GMERS Civil Hospital Sola, Ahmedabad, India
• Dhruvil Patel Department of Internal Medicine, GMERS Civil Hospital, Gandhinagar, India
• Vyoma Patel Department of Internal Medicine, Maimonides Medical Center, Brooklyn, USA
• Shailesh Aggarwal Department of Internal Medicine, Rutgers Monmouth Medical Center, Long Branch, USA
• Hardikkumar Bhanderi Department of Internal Medicine, Rutgers Monmouth Medical Center, Long Branch, USA

sankalpacharyamd@gmail.com

Keywords

Abstract

Dexmedetomidine is a highly selective alpha-2-adrenergic agonist widely used for sedation in the intensive care unit (ICU) and is generally considered well tolerated, with hypotension and bradycardia being the most commonly reported adverse effects. Rarely, dexmedetomidine has been associated with polyuria resembling a diabetes insipidus-like syndrome, particularly during prolonged infusions. We report the case of a 53-year-old male admitted to the ICU for severe alcohol withdrawal who developed profound polyuria during a 5-day dexmedetomidine infusion. Urine output progressively increased to 6.75 litres per day, prompting an extensive evaluation that excluded osmotic diuresis, infection, intracranial pathology, and nephrogenic diabetes insipidus. Laboratory studies demonstrated preserved renal function and normal serum electrolytes. The temporal association between dexmedetomidine initiation and polyuria onset, along with resolution following drug discontinuation, supported the diagnosis of dexmedetomidine-associated polyuria, with a Naranjo adverse drug reaction probability score of 8 indicating a probable association. This case highlights an underrecognized adverse effect of dexmedetomidine. It underscores the importance of monitoring urine output and electrolytes during prolonged infusions to facilitate early recognition, prevent unnecessary diagnostic testing, and avoid complications related to volume depletion and electrolyte imbalance.

References