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Cerebral oedema in enuretic children during low-dose desmopressin treatment: a preventable complication
1Department of Paediatrics, 3rd Faculty of Medicine, Charles University, Praha, Czech Republic. lebl@fnkv.cz
Insights
Low-dose desmopressin (DDAVP) for childhood enuresis can cause cerebral edema. Careful patient selection and fluid intake monitoring are crucial to prevent this serious side effect.
Area of Science:
- Pediatric Nephrology
- Clinical Toxicology
Background:
- Desmopressin (DDAVP) is widely used for treating nocturnal enuresis in children.
- Concerns regarding adverse events, particularly cerebral edema, have been raised with its use.
Observation:
- Seven cases of cerebral edema were reported in children (age 5-11) treated with low-dose desmopressin (7-21 microg/day).
- All affected children experienced unconsciousness but recovered without lasting effects.
- Risk factors included excessive water intake, undiagnosed diabetes insipidus, and non-compliance with fluid restrictions.
Findings:
- Cerebral edema is a potential risk associated with desmopressin treatment for enuresis.
- Inadequate safety measures, including infrequent electrolyte monitoring and poor patient education, contributed to these cases.
- Specific scenarios like preparation for uroflowmetry or hot weather increased risk.
Implications:
- Emphasizes the need for strict patient selection and comprehensive education regarding fluid intake during desmopressin therapy.
- Highlights the importance of regular monitoring for hyponatremia and cerebral edema, especially in at-risk children.
- Suggests a re-evaluation of safety protocols for desmopressin use in pediatric nocturnal enuresis.
Abstract:
Seven cases of cerebral oedema have been observed in enuretic children during low-dose desmopressin (DDAVP) treatment given in a dose of 7-21 microg daily in the Czech Republic between 1995 and 1999, after the drug started to be marketed for this indication and delivered in simple bottles with a dropper. All seven children (age 5-11 years, four boys) experienced a period of unconsciousness but all recovered without sequelae. In most cases, safety measures were underestimated and natraemia was not regularly controlled. Two children developed cerebral oedema after excessive water intake in preparation for uroflowmetry, another one drank much during a hot summer day, in one diabetes insipidus was not recognised and two children were clearly non-compliant with reduced fluid intake on a long-term basis. Only in one child, no risk factor was found. Conclusion. Proper selection and instruction of patients is needed to avert cerebral oedema during treatment with desmopressin for nocturnal enuresis.