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Morbidity and mortality associated with vasopressin replacement therapy in children
V Rizzo1, A Albanese, R Stanhope
1Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK.
Insights
Desmopressin (DDAVP) treatment for children with diabetes insipidus requires caution, especially with risk factors like cortisol deficiency. The oral route appears safer and more convenient, with major changes best managed in-hospital.
Area of Science:
- Pediatric Endocrinology
- Pharmacology
- Nephrology
Background:
- Diabetes insipidus (DI) is a condition characterized by inadequate antidiuretic hormone production or action.
- Desmopressin (DDAVP) is a synthetic analog of vasopressin used to treat DI.
- Understanding DDAVP's adverse reactions and risk factors is crucial for safe pediatric management.
Purpose of the Study:
- To evaluate the incidence of adverse reactions in children treated with DDAVP for DI.
- To identify risk factors associated with DDAVP-related complications.
- To compare the safety and efficacy of different DDAVP administration routes (intramuscular, intranasal, oral).
Main Methods:
- Retrospective study of 103 children with cranial DI.
- Analysis of treatment with intramuscular, intranasal, and/or oral DDAVP over a mean follow-up of 5.2 years.
- Assessment of adverse events, including water intoxication, hyponatremia, and seizures.
Main Results:
- Eight patient deaths occurred, with at least two linked to water intoxication.
- 33 patients experienced major complications (water overload, seizures) or asymptomatic hyponatremia.
- Complications were significantly higher in children with cortisol deficiency (36% vs 6%) and those on carbamazepine (33% vs 10%).
- The oral route showed a trend towards fewer complications, though not statistically significant.
Conclusions:
- DDAVP management in children with DI necessitates vigilance for risk factors like cortisol deficiency and carbamazepine use.
- The oral route of DDAVP administration is suggested as preferable due to convenience and safety.
- Significant dose or formulation adjustments for DDAVP should be performed under hospital supervision.
Objective:
To assess the incidence and associated risk factors of adverse reactions of DDAVP treatment of children with diabetes insipidus, comparing different routes of administration.
Design:
We retrospectively studied 103 children (44 females, 59 males) with cranial diabetes insipidus (mean age 6.9 years at diagnosis) treated with intramuscular (59), intranasal (84) and/or oral (64) DDAVP, over a mean follow-up period of 5.2 years.
Results:
Eight patients died. For at least two children death was related to water intoxication. Major complications (symptomatic water overload with or without seizures) or asymptomatic hyponatraemia were observed in 33 patients. The incidence of total complications was significantly higher in cortisol deficient patients than in those with normal cortisol reserve (36% vs 6%). In patients on concomitant carbamazapine treatment major complications were more frequent in comparison to the remaining patients (33% vs 10%). Although not achieving significance, there were fewer complications using the oral route.
Conclusions:
Caution is needed in managing patients with DI, especially if risk factors such as cortisol deficiency or concomitant carbamazepine treatment are present. The oral route of administration seems to be preferred for both convenience and safety. Major changes in dose and formulation should be undertaken in hospital.