Hyponatremia and seizures in young children given ddavp

Abstract

Desmopressin (DDAVP), a synthetic vasopressin, temporarily corrects bleeding abnormalities associated with mild hemophilia A, von Willebrand disease, and disorders of platelet function. The side effects of DDAVP are considered benign although most of its use has been in adults and older children. We report four children under the age of 2 years who became hyponatremic after intravenous DDAVP administration (0.3 microgram/kg). Three of them developed grand mal seizures. A review of the literature and these cases indicate that associated risk factors for hyponatremia after DDAVP administration include stress, surgery, anesthesia and narcotics (endogenous release of antidiuretic hormone), vomiting (loss of Na+), liver disease (hindered metabolism of DDAVP), renal tubular acidosis (chronically low serum Na+), multiple doses of DDAVP, and overhydration with hyponatremic fluids. DDAVP is not a benign drug in this age group and shows a serious potential for hyponatremia and seizures. Fluid restriction, avoidance of hyponatremic solutions, and close monitoring of serum electrolytes and urine output for at least 15-20 hr after the administration of DDAVP, when used in children under the age of 2 years, is warranted.

Principles of care for the diagnosis and treatment of von Willebrand disease

“…32 Hyponatremia and volume overload due to the antidiuretic effect of DDAVP occur rarely, but small children who have received closely repeated infusions are particularly at risk. 33 To avoid this complication, fluid intake should be limited during DDAVP treatment. Finally, this drug should be used cautiously in patients with uncontrolled hypertension, recent myocardial infarction or stroke, or suffering from angina, as thrombotic events have been reported to occur following its use.…”

The use of desmopressin as a hemostatic agent: A concise review

“…Because of the mild antidiuretic effect of the agent, fluid intake should be regulated in the 24 hr following administration. Fortunately, episodes of fluid overload and severe hyponatremia are rare, and most often involve the very young patients who received closely repeated infusions [67,68]. Therefore, it is generally recommended that desmopressin is used cautiously in small children or in patients with congestive heart failure.…”

The diagnosis and treatment of von Willebrand disease in children

“…Water retention, hyponatremia and seizures have been reported in young children and infants who received multiple doses of DDAVP and aggressive hydration (16). Guidelines for the use of DDAVP in young children have been reported by Smith et al (17) and include baseline electrolytes and serum osmolality, fluid restriction to 75% maintenance, close monitoring of serum sodium and urine output for 24 h, and restriction of repeat doses of DDAVP if possible (17). DDAVP is contraindicated in patients with Type 2B or 3 VWD.…”