Coma and Seizures due to Severe Hyponatremia and Water Intoxication in an Adult with Intranasal Desmopressin Therapy for Nocturnal Enuresis

Odeh, Majed; Oliven, Arie

doi:10.1177/00912700122010320

Cited by 28 publications

(9 citation statements)

References 15 publications

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“…In general, dosage reduction is recommended for patients in whom systemic clearance is reduced by 50%[34], because plasma concentrations are inversely correlated with this parameter. Desmopressin does not have a narrow therapeutic range, but adverse events may occur with patients at high doses of desmopressin, leading to prolonged antidiuretic effects (and increasing the risk of hyponatraemia) [16, 17]. Hence, although desmopressin appears to be safe and well‐tolerated by patients with impaired renal function, great caution should be exercised when titrating towards an efficient dosage regimen, if patients with moderately or severely impaired renal function are to be treated with desmopressin at all.…”

Section: Discussionmentioning

confidence: 99%

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Pharmacokinetics and renal excretion of desmopressin after intravenous administration to healthy subjects and renally impaired patients

Agersø¹,

Larsen²,

Riis

et al. 2004

Brit J Clinical Pharma

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ObjectiveTo evaluate the influence of renal impairment on the pharmacokinetics of desmopressin. MethodsTwenty-four subjects were enrolled in the study, 18 with varying degrees of renal impairment and six healthy volunteers. Each subject received a single intravenous dose of 2 m g desmopressin. Blood and urine samples were collected for 24 h and assayed for desmopressin by radioimmunoassay. Plasma concentrations and the amounts of desmopressin excreted in the urine were analysed simultaneously by use of mixed effects modelling. ResultsOnly mild adverse events were observed. Both the renal and the nonrenal clearance of desmopressin were found to vary with the creatinine clearance (CrCL). A decrease of 1.67% in the CrCL (corresponding to 1 ml min -1 from 60 ml min -1 ) was found to cause a 1.74% decrease in the renal clearance and a 0.93% decrease in the nonrenal clearance. The fall in renal clearance caused the amount of desmopressin excreted in urine to decrease from 47% in healthy subjects to 21% in the patients with severe renal impairment. The mean systemic clearance of desmopressin was 10 litres h -1 in healthy subjects and 2.9 litres h -1 in patients with severe renal impairment (difference -7.5 litres h -1 , 95% CI [ -11; -4.3] litres h -1 ). Correspondingly, the mean terminal half-life, was 3.7 h in healthy subjects and 10 h in patients with severe renal impairment (difference 6.7 h, 95% CI [4.0; 9.4] h). ConclusionAlthough desmopressin appears to be safe and well-tolerated by patients with impaired renal function, great caution should be exercised when titrating towards an efficient dosage regimen if patients with moderately or severely impaired renal function are to be treated with desmopressin at all.

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Section: Discussionmentioning

confidence: 99%

“…Desmopressin has been demonstrated to be an effective treatment of nocturia [11][12][13][14][15], and side-effects have only rarely been reported [16,17]. However, a relatively large proportion of elderly people may have reduced renal function [18].…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics and renal excretion of desmopressin after intravenous administration to healthy subjects and renally impaired patients

Agersø¹,

Larsen²,

Riis

et al. 2004

Brit J Clinical Pharma

View full text Add to dashboard Cite

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“…Periodic sodium serum level measurements together with adequate fluid restriction and the use of the lowest required dose should prevent this serious complication. 28 For these reasons, desmopressin is contraindicated in severe cognitive impairment unless caregivers can be relied upon to control fluid intake and the dosage used. Amitriptyline and imipramine may reduce nocturnal urine production as well, besides their inherent anticholinergic effects.…”

Section: Drugsmentioning

confidence: 99%

Conservative bladder management in advanced multiple sclerosis

Ridder

Ost

et al. 2005

Mult Scler

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Anticholinergics and intermittent catheterization are the cornerstones of bladder management in early multiple sclerosis (MS). In advanced MS however, bladder management is based more on tradition than on evidence. Nurses seem to deal with catheter problems and chronic incontinence. Despite the abundant use of indwelling catheters, there is a lack for guidelines on catheter-induced problems. The psychosexual and social impact of bladder problems in advanced MS is often neglected. The international multidisciplinary special interest group on sexual, urological and bowel dysfunction in MS (SUBDIMS) as a special interest group of the Rehabilitation in Multiple Sclerosis (RIMS) was confronted with a high variability in practice and a lack of guidelines. A literature review was prepared during three multidisciplinary expert meetings. This review will be the basis of further initiatives to improve the urological treatment of patients with advanced MS.

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“…However, the side‐effects are minimal with a low dose of desmopressin. In the present study, two patients had oedema and one had itching; there were none with water intoxication, hyponatraemia or other severe side‐effects reported previously [13]. However, more patients need to be evaluated for potential side‐effects.…”

Section: Discussionmentioning

confidence: 44%

Clinical observations of the effect of antidiuretic hormone on nocturia in elderly men

Lin

et al. 2005

BJU International

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or anticholinergics, e.g. oxybutynin, tolterodine, and propantheline bromide. We assessed the effect of desmopressin using a quantitative nocturia score and analysed its synergistic effect with α -blockers. RESULTSThe mean frequency of nocturia was 6.1 before desmopressin and most (86%) patients had an improvement in nocturia within 1-12 weeks of treatment with desmopressin. There was a 43% reduction in nocturia after using desmopressin ( P < 0.001). The correlation coefficient between the number of nocturnal voids and the reduction in nocturia after treatment with desmopressin was 0.756, indicating that the more severe the nocturia, the more effective was desmopressin. CONCLUSIONSDesmopressin is effective for refractory nocturia in elderly men with no nocturnal polyuria, and has limited side-effects.

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Coma and Seizures due to Severe Hyponatremia and Water Intoxication in an Adult with Intranasal Desmopressin Therapy for Nocturnal Enuresis

Cited by 28 publications

References 15 publications

Pharmacokinetics and renal excretion of desmopressin after intravenous administration to healthy subjects and renally impaired patients

Pharmacokinetics and renal excretion of desmopressin after intravenous administration to healthy subjects and renally impaired patients

Conservative bladder management in advanced multiple sclerosis

Clinical observations of the effect of antidiuretic hormone on nocturia in elderly men

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