Desmopressin associated symptomatic hyponatremic hypervolemia in children. Are there predictive factors?
OBJECTIVE
Desmopressin is widely used in primary nocturnal enuresis, bleeding disorders, central diabetes insipidus and diagnostic urine concentration testing. Hyponatremic hypervolemia leading to seizures has been reported as a rare but potentially life threatening side effect of desmopressin therapy. We sought to identify factors that predispose patients to hyponatremia and to find predictive factors associated with increased risk of water intoxication.


METHODS
We report 13 novel cases of desmopressin associated water intoxication and review the literature. A total of 93 instances of symptomatic hyponatremia during desmopressin treatment in children were identified. Specific data were reported in 58 of 93 cases. These 58 cases, in addition to our 13 novel cases, were further analyzed.


RESULTS
All children were treated with intranasal or intravenous desmopressin. No patient received oral desmopressin. Younger children are at greater risk for water intoxication than older children. The risk is particularly high at the beginning of desmopressin therapy. A total of 45 patients (63%) had prodromal symptoms, eg nausea, vomiting and headache. In 10 cases (14%) desmopressin was prescribed without an evident need.


CONCLUSIONS
Based on this analysis, we conclude that the use of desmopressin should be cautiously considered, careful monitoring should be performed during the initiation of therapy, and particular care should be taken when treating young children and when prodromal symptoms such as nausea, vomiting and headaches occur.
Thumfart
Julia
J
Departments of Pediatric Nephrology, Charité Children's Hospital, Berlin, Germany.
Roehr
Charles-Christoph
CC
Kapelari
Klaus
K
Querfeld
Uwe
U
Eggert
Paul
P
Müller
Dominik
D
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003894:Deamino Arginine Vasopressin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced*; D020896:Hypovolemia / Q000139:chemically induced*; D008297:Male; D012076:Renal Agents / Q000009:adverse effects*; D014869:Water Intoxication / Q000139:chemically induced*
D012076:Renal Agents; D003894:Deamino Arginine Vasopressin