Morbidity and mortality associated with vasopressin replacement therapy in children.
OBJECTIVE
To assess the incidence and associated risk factors of adverse reactions of DDAVP treatment of children with diabetes insipidus, comparing different routes of administration.


METHODS
We retrospectively studied 103 children (44 females, 59 males) with cranial diabetes insipidus (mean age 6.9 years at diagnosis) treated with intramuscular (59), intranasal (84) and/or oral (64) DDAVP, over a mean follow-up period of 5.2 years.


RESULTS
Eight patients died. For at least two children death was related to water intoxication. Major complications (symptomatic water overload with or without seizures) or asymptomatic hyponatraemia were observed in 33 patients. The incidence of total complications was significantly higher in cortisol deficient patients than in those with normal cortisol reserve (36% vs 6%). In patients on concomitant carbamazapine treatment major complications were more frequent in comparison to the remaining patients (33% vs 10%). Although not achieving significance, there were fewer complications using the oral route.


CONCLUSIONS
Caution is needed in managing patients with DI, especially if risk factors such as cortisol deficiency or concomitant carbamazepine treatment are present. The oral route of administration seems to be preferred for both convenience and safety. Major changes in dose and formulation should be undertaken in hospital.
Rizzo
V
V
Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK.
Albanese
A
A
Stanhope
R
R
D000281:Administration, Intranasal; D000284:Administration, Oral; D000293:Adolescent; D001834:Body Water / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003919:Diabetes Insipidus / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014667:Vasopressins / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
D014667:Vasopressins; D003894:Deamino Arginine Vasopressin