title: Perioperative incidence and management of hyponatremia in vWD patients undergoing adenotonsillectomy.
abstract: OBJECTIVE
  To analyze the incidence and severity of hyponatremia in patients receiving synthetic desmopressin (DDAVP) in the perioperative setting of oropharyngeal surgery in the treatment of von Willebrand disease and to propose a standardized protocol for perioperative fluid resuscitation and postoperative sodium monitoring after DDAVP administration.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  A retrospective medical record review in an academic pediatric medical center was conducted. From October 1, 2002, to February 1, 2009, all patients undergoing adenotonsillectomy and receiving DDAVP preoperatively for the treatment of von Willebrand disease were identified. A total of 76 patients were identified by initial database review; 63 patients were included in the study, and 13 patients were excluded secondary to incomplete data. DDAVP dose and timing, perioperative fluid volume and composition, and postoperative sodium levels were collected. Extreme adverse events related to hyponatremia were recorded.
  
  
  RESULTS
  Forty-seven of 63 (74.6%) patients developed some degree of hyponatremia after DDAVP administration, and six of 63 (9.5%) patients developed extreme hyponatremia, with the degree of hyponatremia related to the volume of perioperative fluid resuscitation. The sodium nadir occurred within 9 to 20 hours after DDAVP administration. No serious adverse events related to hyponatremia were recorded during the study period.
  
  
  CONCLUSIONS
  The incidence of hyponatremia in children receiving DDAVP for prophylaxis of intraoperative bleeding following oropharyngeal surgery is high. The degree of hyponatremia is related to the perioperative fluid volume administered. A protocol for DDAVP administration, perioperative fluid resuscitation, and postoperative sodium monitoring that aims to reduce the incidence of hyponatremia in this population is proposed.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: H Carter
authors.initials: HC
authors.lastname: Davidson
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Stapleton
authors.forename: Margaretha L
authors.initials: ML
authors.lastname: Casselbrant
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Kitsko
mesh_terms: D000046:Academic Medical Centers; D000233:Adenoidectomy / Q000009:adverse effects* / Q000379:methods; D000293:Adolescent; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003894:Deamino Arginine Vasopressin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007010:Hyponatremia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D015994:Incidence; D008297:Male; D019990:Perioperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014842:von Willebrand Diseases / Q000175:diagnosis* / Q000601:surgery
chemical_list: D003894:Deamino Arginine Vasopressin