Convulsion and coma after intranasal desmopressin in cystic fibrosis.

Simmonds, E. John; Mahony, Michael; Little, J. Maxwell

doi:10.1136/bmj.297.6663.1614

Cited by 37 publications

(15 citation statements)

References 8 publications

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“…However, some authors suggest evening polydipsia might be more common in patients with nocturnal enuresis than is generally appreciated [5,17,25]. In the six case reports where ingestion of a large amount of fluid was considered to be a contributing factor, the circumstances leading to fluid ingestion included intravenous therapy, beer drinking, habitual ingestion, and treatment of hiccups, diarrhea, and crying [1,2,4,13,26,32]. Beach et al [2] calculated the serum sodium should not fall greater than 5-7 mmol/1 if a patient treated with DDAVP does not ingest greater than 30 ml of fluid per kg body weight during the 4 h prior to a dose of DDAVP and for 12 h after the dose [2].…”

Section: Discussionmentioning

confidence: 97%

“…One patient who developed a seizure had cystic fibrosis [26]. The authors speculated the abnormal electrolyte transport in patients with cystic fibrosis might increase the risk of symptomatic hyponatremia.…”

Section: Discussionmentioning

confidence: 98%

“…Excess fluid intake was identified as a contributing factor in 6 of the 11 case reports [1,2,4,13,26,32]. Evening fluid restriction is a common practice in most patients with nocturnal enuresis before they seek medical attention.…”

Section: Discussionmentioning

confidence: 98%

“…Six of the 11 patients had other symptoms preceding the seizure or altered level of consciousness [t, 2,13,19,26,32]. Five patients had headache, five vomited, and one had nausea [1,2,13,19,26,32].…”

Section: Discussionmentioning

confidence: 99%

“…The authors speculated the abnormal electrolyte transport in patients with cystic fibrosis might increase the risk of symptomatic hyponatremia. The patient was receiving intravenous fluid therapy for several days prior to developing symptoms, so an increased fluid intake might also be a risk factor [26].…”

Section: Discussionmentioning

confidence: 99%

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Hyponatremia in patients with nocturnal enuresis treated with DDAVP

1996

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Hyponatremia in patients with nocturnal enuresis treated with DDAVP

1996

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Intranasal Desmopressin‐Induced Hyponatremia

Williford,

Bernstein

1996

Pharmacotherapy

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Desmopressin is a commonly used, well‐tolerated agent for the treatment of primary nocturnal enuresis and central diabetes insipidus. Intranasal desmopressin provides symptomatic relief with few serious complications. A 29‐year‐old woman with a long history of primary nocturnal enuresis began treatment with intranasal desmopressin. Although the enuresis ceased, she developed throbbing headaches, nausea, vomiting, paresthesia, lethargy, fatigue, and altered mental status over the next 7 days. When she came to the emergency room her sodium concentration was 127 mmol/L. The history of desmopressin use was not obtained at that time. She was treated with intravenous fluids and discharged. The symptoms returned and worsened over the next 4 days, and she returned to the emergency room stuporous. A repeat sodium was 124 mmol/L, and she was admitted. The history of desmopressin use was still not available. Medical evaluations included computerized tomography, lumbar puncture, complete blood counts, serum chemistries, and serologies. The next morning the woman was improved and informed clinicians of her desmopressin use. Without other causes for the hyponatremia, she was diagnosed with the syndrome of inappropriate antidiuretic hormone, presumably caused by desmopressin. Within 24 hours of fluid restriction and cessation of desmopressin, her symptoms and hyponatremia resolved. A review of the literature found 11 children and 2 adults in whom intranasal desmopressin was associated with hyponatremia, all of whom experienced seizures or altered mental status. Our patient illustrates the importance of early recognition and treatment of hyponatremia before the onset of seizures. When vague symptoms develop during desmopressin therapy, hyponatremia must be considered as part of the differential diagnosis. It may also be prudent to screen for electrolyte abnormalities in patients taking this agent to prevent serious iatrogenic complications.

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Nocturnal enuresis

Alon

1995

Pediatr Nephrol

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Nocturnal enuresis is a very common pediatric problem which often has strong genetic roots. In the vast majority of children it resolves spontaneously, with time, therefore research and treatment of bedwetting cannot carry any risk to the child. The research on the etiology of bedwetting has been focused on sleep disturbances, nocturnal urine production and functional bladder capacity. So far it has not provided conclusive evidence of the pathophysiology of the phenomenon. It is possible that different factors may be predominant in different age groups. Although bedwetters are basically mentally healthy, several studies have shown that the problem may cause secondary emotional and social problems which can be alleviated with successful intervention. Of the treatment modalities currently available to the pediatrician, the most effective is the moisture alarm. Combined with its safety and low cost it should become the treatment of choice in most cases.

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Convulsion and coma after intranasal desmopressin in cystic fibrosis.

Cited by 37 publications

References 8 publications

Hyponatremia in patients with nocturnal enuresis treated with DDAVP

Hyponatremia in patients with nocturnal enuresis treated with DDAVP

Intranasal Desmopressin‐Induced Hyponatremia

Nocturnal enuresis

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