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Intranasal desmopressin-induced hyponatremia
1Department of Family Practice Womack Army Medical Center, Ft. Bragg, NC 28307, USA.
Pharmacotherapy
|January 1, 1996
Summary
Intranasal desmopressin can cause hyponatremia, a dangerous drop in sodium levels, leading to symptoms like confusion and fatigue. Early recognition and discontinuation of desmopressin are crucial for patient safety.
Area of Science:
- Endocrinology
- Nephrology
- Pharmacology
Background:
- Desmopressin is a synthetic analog of vasopressin used to treat primary nocturnal enuresis and central diabetes insipidus.
- Intranasal desmopressin is generally well-tolerated, offering symptomatic relief with minimal serious complications.
Observation:
- A 29-year-old woman developed severe hyponatremia (sodium levels of 127 and 124 mmol/L) after initiating intranasal desmopressin for nocturnal enuresis.
- Her symptoms included headache, nausea, vomiting, paresthesia, lethargy, fatigue, and altered mental status, progressing to stupor.
Findings:
- The patient was diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) presumed to be caused by desmopressin.
- Discontinuation of desmopressin and fluid restriction led to rapid resolution of symptoms and hyponatremia.
- Literature review identified 13 previous cases (11 children, 2 adults) of desmopressin-associated hyponatremia, all presenting with seizures or altered mental status.
Implications:
- This case highlights the importance of considering desmopressin-induced hyponatremia in patients presenting with vague symptoms during therapy.
- Early recognition and prompt management of hyponatremia are essential to prevent severe neurological complications like seizures.
- Screening for electrolyte abnormalities in patients on desmopressin may be prudent to avoid iatrogenic complications.