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J Thorac Cardiovasc Surg 2009;138:491-492
© 2009 The American Association for Thoracic Surgery

Brief Clinical Report

Vasopressin withdrawal associated with massive polyuria

^a Mayo Clinic Rochester Department of Pharmacy, Rochester, Minn
^b Department of Anesthesiology, Division of Cardiovascular Anesthesiology, Mayo Clinic Rochester, Rochester, Minn
^c Department of Cardiac Surgery, Division of Cardiovascular Surgery, Mayo Clinic Rochester, Rochester, Minn
^d Department of Anesthesiology, Division of Cardiovascular Anesthesiology, Mayo Clinic Rochester, Rochester, Minn

Received for publication February 13, 2008; revisions received May 22, 2008; accepted for publication June 15, 2008.

^_* Address for reprints: William J. Mauermann, MD, 200 First St SW–Mb 2-752, Rochester, MN 55909. (Email: mauermann.william@mayo.edu).

The first 20% of the full text of this article appears below.

	Introduction

 
Vasopressin has demonstrated success in the treatment of vasodilatory shock.¹ It is also frequently used to manage decreased systemic vascular resistance (SVR) during or after cardiac surgery with cardiopulmonary bypass. We report a case of massive polyuria and increasing serum tonicity after withdrawal of a vasopressin infusion in a patient after cardiac surgery.

	Clinical Summary

 
A 32-year-old man with Marfan's syndrome treated with atenolol and lisinopril underwent repair of an ascending aortic aneurysm, closure of a patent foramen ovale, and mitral valve repair. After termination of cardiopulmonary bypass, a vasopressin infusion (0.08 U/min) was initiated for persistent hypotension caused by decreased SVR (456 dynes · sec^–1 · cm^–5). The vasopressin infusion was continued for 3 days, at which time the infusion was withdrawn over 12 hours. During this period, the patient was awake and alert and had free access to oral fluids.

Within 3 hours of discontinuing the vasopressin infusion, the patient's urine output increased to more than 1 L/h without any other medication changes, and oral fluid intake averaged 300 mL/h (Figure 1 ). Specifically, no diuretics had been administered for at least 24 hours. The serum sodium concentration (normal range, 135–145 mmol/L) increased to 135 mmol/L from 129 . . . [Full Text of this Article]