ICU 護理師照顧一位 40 歲剛開顱切除腦腫瘤男性。過去一小時尿量暴增至 850 mL 稀薄淡色尿液，血壓降至 92/58 mmHg。優先護理行動為何？
An ICU nurse evaluates a 40-year-old male post-craniotomy for a brain tumor. Over the last hour, urine output has surged to 850 mL of dilute, pale urine, and BP has dropped to 92/58 mmHg. Which nursing action is the priority?
- AAdminister an IV fluid bolus and notify the neurosurgeon for impending hypovolemia from possible diabetes insipidus.✓ 正解給予靜脈輸液衝刺劑量，並通知神經外科醫師，以處理可能因糖尿病insipidus引起的低血容量。
- BPerform a deep neurological pupil assessment.進行深度的神經 pupils 評估。
- CIncrease the ventilator FiO2 to combat the hypotension.增加呼吸器的 FiO2 以對抗低血壓。
- DDocument the diuresis as an expected positive postoperative response.將多尿記錄為術後預期的正面反應。
開顱術後突然大量稀薄尿液 + 血壓下降 = 中樞性尿崩症（diabetes insipidus, DI）— 因下視丘/腦下垂體後葉受傷導致 ADH 分泌不足，腎臟無法保水。 選項 A 正確：立即靜脈補液預防低血容性休克並通報神經外科以給予 desmopressin (DDAVP)。 選項 D 錯誤：每小時 850 mL 稀薄尿不是正常現象。 選項 C 錯誤：低血壓不是缺氧，增加 FiO2 無效。 選項 B 錯誤：神經評估雖重要但非首要救命動作。
Sudden polyuria of dilute urine + falling BP after craniotomy = central diabetes insipidus (DI) from hypothalamic/posterior pituitary injury impairing ADH secretion. B correct: Immediate IV fluid bolus prevents hypovolemic shock; notify neurosurgeon to start desmopressin (DDAVP). A incorrect: 850 mL/hour dilute urine is abnormal. C incorrect: Hypotension is not hypoxia—FiO2 won't help. D incorrect: Neuro assessment important but not the lifesaving priority.
腦外傷/開顱術後三大經典殺手：IICP (腦壓高)、SIADH (水腫)、DI (尿崩症)。看到術後異常狂尿，毫無疑問就是發生 DI，馬上灌點滴補水跟打 DDAVP。這在高級急救與國考檢傷中列居首位。