Severe hyponatraemia secondary to desmopressin therapy in von Willebrand's disease.
A 42-year-old female with von Willebrand's disease was managed with desmopressin and tranexamic acid to aid haemostasis following a vaginal hysterectomy. Severe acute hyponatraemia (134 to 108 mmol/l) developed over two days, culminating in a generalized tonic-clonic seizure and cerebral oedema. Fluid restriction, cessation of desmopressin and hypertonic saline administration led to a full recovery. Desmopressin is known to reduce free water elimination and produce hyponatraemia, but its extent and rate of development in this patient was surprising. Close monitoring of serum sodium and fluid balance is recommended in these patients.
Bertholini
D M
DM
Department of Anaesthesia and Intensive Care, Townsville General Hospital, Queensland.
Butler
C S
CS
D000208:Acute Disease; D000328:Adult; D003894:Deamino Arginine Vasopressin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006490:Hemostatics / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced*; D007044:Hysterectomy; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D014148:Tranexamic Acid / Q000627:therapeutic use; D014842:von Willebrand Diseases / Q000188:drug therapy*
D006490:Hemostatics; D014148:Tranexamic Acid; D003894:Deamino Arginine Vasopressin