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Delay in desmopressin therapy: Disaster in waiting
Christian Kroll1, Arya Zandvakili2
1Department of Pharmacy, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA.
Journal of Clinical Pharmacy and Therapeutics
|November 14, 2022
Summary
Central diabetes insipidus (DI) management requires strict desmopressin adherence. Stopping desmopressin for over 24 hours risks a rapid DI crisis and hypernatremia, as seen in a recent case study.
Area of Science:
- Endocrinology
- Nephrology
- Internal Medicine
Background:
- Central diabetes insipidus (DI) necessitates consistent desmopressin treatment.
- Limited data exists on hypernatremia development following desmopressin cessation.
Observation:
- An elderly female patient with central DI experienced a rapid serum sodium increase from 141 to 171 mEq/L.
- This occurred within 48-72 hours of discontinuing oral desmopressin therapy.
Findings:
- The patient's DI crisis was successfully managed with intravenous desmopressin and fluid resuscitation.
- The case highlights the potential for rapid and severe hypernatremia upon desmopressin withdrawal.
Implications:
- Clinicians should advise patients against withholding desmopressin for extended periods.
- A desmopressin holiday should not exceed 24 hours to prevent acute DI decompensation.
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