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Hyponatraemic convulsion secondary to desmopressin treatment for primary enuresis
1Department of Accident and Emergency Medicine, Birmingham Heartlands Hospital, Bordesley Green East.
Insights
Accidental overdose of intranasal desmopressin (DDAVP) in children can cause water intoxication, leading to seizures and coma. Supervised administration and education on fluid intake risks are crucial for safe treatment of nocturnal enuresis.
Area of Science:
- Pediatrics
- Pharmacology
- Nephrology
Background:
- Nocturnal enuresis is common in children and can cause significant emotional distress.
- Intranasal desmopressin (DDAVP) is a common treatment for nocturnal enuresis.
- Self-administration by children can lead to accidental overdose.
Observation:
- A 6-year-old child presented with convulsions and coma after unsupervised intranasal DDAVP administration.
- This presentation is consistent with water intoxication, a rare but serious adverse effect of DDAVP.
- Symptoms include seizures and altered mental status.
Findings:
- Water intoxication from intranasal DDAVP overdose is a serious risk in pediatric patients.
- Prompt management involves drug cessation, fluid restriction, and seizure control.
- Recovery is typically rapid and complete with appropriate medical intervention.
Implications:
- Parental supervision of intranasal DDAVP administration in children is essential to prevent overdose.
- Educating families about the risks of excessive fluid intake with DDAVP is critical.
- This case highlights the importance of safe medication practices in pediatric care.
Abstract:
The case of a 6 year old child who presented with convulsions and coma after unsupervised self administration of intranasal desmopressin (DDAVP) for nocturnal enuresis is presented. Children with enuresis can be embarassed by their condition and may believe that multiple doses of their nasal spray may bring about a rapid resolution. Water intoxication is an uncommon but serious adverse effect of treatment with intranasal DDAVP. These patients may present with seizure, mental state changes, or both. Basic management consists of stopping the drug, fluid restriction, and suppressive treatment for seizures. Recovery is usually rapid and complete. Administration of the nasal spray in children should be supervised by parents to prevent highly motivated children from accidental overdose. The risks of high fluid intake need to be carefully explained to both parents and children.