Transient Arginine Vasopressin Deficiency in Living-donor Liver Transplant Recipient: A Case Report

REPORT11 hours, with an estimated blood loss of 1050 mL; blood loss was replaced by blood products and crystalloids, noradrenaline infusion and steroids intraoperatively.On arrival to the intensive care unit (ICU), the patient was on noradrenaline infusion with a cumulative positive intraoperative fluid balance of 4.5 L. Standard protocolized bundled care for transplant recipients was administered.After optimization of the clinical condition, the patient was taken off the ventilator on the 1st postoperative day (POD) and on to high-flow nasal cannula.During the course, the patient developed progressive polyuria (peak of 450 mL/hour) and hypernatremia, reaching peak levels on POD-3.The patient had peak sodium of 164, osmolality of 329 mOsm/kg, and urine osmolality of 131 mOsm/kg.The patient continued to remain hypotensive, requiring vasopressor support, and due to DI-like features, received desmopressin.After desmopressin supplementation, urine osmolality increased by more than twice the prior baseline osmolality, that is, 301 mOsm/kg, 1-