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Hyponatremia and seizures in young children given DDAVP
T J Smith1, J C Gill, D R Ambruso
1Department of Pediatrics, University of Colorado School of Medicine, Denver 80262.
Insights
Desmopressin (DDAVP) can cause severe hyponatremia and seizures in children under two. Close monitoring and fluid restriction are crucial after DDAVP administration in this age group.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Hematology
Background:
- Desmopressin (DDAVP), a synthetic vasopressin analog, is used to treat bleeding disorders like hemophilia A and von Willebrand disease.
- DDAVP's side effects are generally considered benign, with most clinical experience in adults and older children.
Observation:
- Four children under two years old experienced hyponatremia after intravenous DDAVP (0.3 mcg/kg).
- Three of these children developed grand mal seizures secondary to hyponatremia.
Findings:
- Risk factors for DDAVP-induced hyponatremia in young children include stress, surgery, anesthesia, narcotics, vomiting, liver disease, renal tubular acidosis, multiple doses, and overhydration with hypotonic fluids.
- DDAVP is not benign in children under two, posing a significant risk of hyponatremia and seizures.
Implications:
- Careful patient selection and monitoring are essential when administering DDAVP to infants and toddlers.
- Fluid restriction, avoidance of hypotonic solutions, and close monitoring of electrolytes and urine output for 15-20 hours post-administration are recommended for children under two receiving 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.