title: Desmopressin acetate (DDAVP)-associated hyponatremia and brain damage: a case series.
abstract: BACKGROUND
  Desmopressin (DDAVP) is typically prescribed for central diabetes insipidus, von Willebrands disease and for enuresis. DDAVP-associated hyponatremia is a known complication of DDAVP therapy. The currently recommended treatment for this condition calls for discontinuing DDAVP as part of the initial therapy. This recommendation could lead to a water diuresis and potentially over-correction of the serum sodium.
  
  
  METHODS
  The 15 patients in this case series developed symptomatic DDAVP-associated hyponatremia and were admitted to acute care hospitals. Thirty-eight percent presented with symptomatic hyponatremia and 62% developed symptomatic hyponatremia due to concomitant DDAVP and hypotonic intravenous fluid administration during a hospital stay. Group 1 patients (n = 13) were treated by withholding DDAVP and providing intravenous saline. Group 2 patients (n = 2) were treated by continuing DDAVP and providing DDAVP and intravenous hypertonic saline.
  
  
  RESULTS
  Among Group 1 patients, in whom DDAVP was withheld as initial management of DDAVP-associated hyponatremia (n = 13), the mean change in serum sodium in the first 2 days of treatment was 37.1 ± 8.1 mEq/L. The ultimate outcome in this group was death in 23%, severe brain damage in 69% and moderate brain damage in 8%. In Group 2 patients, in whom DDAVP was continued (n = 2) as part of the initial management strategy, the mean change in serum sodium was 11.0 ± 0 mEq/L in the first 2 days. The ultimate outcome was survival without neurological sequelae in both cases.
  
  
  CONCLUSIONS
  Discontinuing DDAVP in a patient with symptomatic DDAVP-associated hyponatremia can lead to rapid correction of the serum sodium and resultant severe neurological injury. In contrast, continuing the medication while correcting DDAVP-associated hyponatremia may lead to better outcomes by avoiding over-correction of the serum sodium. Thus, an alternative approach that we propose is to continue DDAVP as part of the initial management of this disorder.
authors.affiliation: Department of Nephrology, Watson Clinic, LLP - Lakeland, FL, USA.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Achinger
authors.affiliation: University of California School of Medicine, San Francisco, CA, USA.
authors.forename: Allen Israel
authors.initials: AI
authors.lastname: Arieff
authors.affiliation: University of California Irvine, Irvine, CA, USA.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: Renal Consultants of Houston, Houston, TX, USA Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Ayus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050034:Antidiuretic Agents / Q000009:adverse effects; D001921:Brain / Q000187:drug effects*; D003894:Deamino Arginine Vasopressin / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced / Q000150:complications / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000209:etiology* / Q000378:metabolism; D012307:Risk Factors; D012462:Saline Solution, Hypertonic; D055815:Young Adult
chemical_list: D050034:Antidiuretic Agents; D012462:Saline Solution, Hypertonic; D003894:Deamino Arginine Vasopressin
keywords: DDAVP; central pontine myelinolysis; desmopressin; hyponatremia