title: Severe signs of hyponatremia secondary to desmopressin treatment for enuresis: a systematic review.
abstract: OBJECTIVE
  Dilutional hyponatremia is a serious adverse effect of desmopressin, a vasopressin analog that is widely prescribed to manage monosymptomatic enuresis. The presentation of hyponatremia, largely related to cerebral dysfunction, can include severe signs like altered mental status and seizures.
  
  
  METHODS
  We reviewed the literature dealing with altered mental status or seizures in enuretic subjects on desmopressin. The retained publications included patients who were described individually, revealing data on mode of administration, further identifiable factors predisposing to hyponatremia, presentation and clinical course.
  
  
  RESULTS
  We found 54 cases of hyponatremia secondary to desmopressin treatment presenting with altered mental status or seizures. In most cases the complication developed 14 days or less after starting desmopressin. An intranasal formulation had been used in 47 patients. Excess fluid intake was documented as a contributing factor in at least 22 cases. In 6 cases severe signs of hyponatremia developed in the context of intercurrent illnesses.
  
  
  CONCLUSIONS
  Altered mental status or seizures are very rare but recognized complications of desmopressin in enuresis. This complication mostly develops in subjects managed with the intranasal formulation 14 days or less after starting the medication, following excess fluid intake and during intercurrent illnesses.
authors.affiliation: Integrated Department of Pediatrics, Ente Ospedaliero Cantonale Ticinese, and University of Bern, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Lucchini
authors.forename: Giacomo D
authors.initials: GD
authors.lastname: Simonetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ceschi
authors.forename: Sebastiano A G
authors.initials: SA
authors.lastname: Lava
authors.forename: Pietro B
authors.initials: PB
authors.lastname: Faré
authors.forename: Mario G
authors.initials: MG
authors.lastname: Bianchetti
mesh_terms: D050034:Antidiuretic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage / Q000009:adverse effects*; D004775:Enuresis / Q000188:drug therapy*; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced* / Q000175:diagnosis*; D053609:Lethargy / Q000139:chemically induced / Q000175:diagnosis; D012640:Seizures / Q000139:chemically induced / Q000175:diagnosis; D012720:Severity of Illness Index
chemical_list: D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin
keywords: Altered mental status; Convulsions; Desmopressin; Enuresis; Hyponatremia