Acquired Diabetes Insipidus with Hypovolemic Shock Associated with Dexmedetomidine, Propofol, and Sevoflurane: A Case Report and Literature Review

Background: Dexmedetomidine, propofol, and sevoflurane are widely used anesthetic agents. Reports of water metabolism disturbances, particularly drug-induced diabetes insipidus (DI), associated with these agents are rare. We present a case of DI following combined administration of multiple anesthetics that progressed to hypovolemic shock. Case presentation: A 51-year-old male underwent transurethral seminal vesiculoscopy with lithotripsy under general anesthesia. Intraoperative medications included dexmedetomidine (30 µg), propofol (13 mL of 1% solution), sevoflurane (10 mL), dezocine, dexamethasone, parecoxib, and others; 500 mL lactated Ringer’s solution was administered intraoperatively. No urinary catheter was placed. Postoperatively, the patient developed persistent polyuria lasting approximately 18 hours, resulting in marked hypernatremia and progressive hypovolemia that culminated in severe hypovolemic shock. He required aggressive fluid resuscitation and vasopressor support. After supportive therapy and cessation of suspected offending agents, urine output gradually decreased, serum sodium normalized, hemodynamics stabilized, and the patient was discharged from the ICU on postoperative day 3. Conclusion: Clinicians should be vigilant for the potential diuretic complications associated with commonly used anesthetic agents, especially when administered in combination. Early recognition, appropriate fluid management, and vasopressin replacement when indicated may be critical to prevent severe outcomes.