deamino-arginine-vasopressin and Seizures

Dilutional hyponatremia is a serious adverse effect of desmopressin, a vasopressin analog that is widely prescribed to manage monosymptomatic enuresis. The presentation of hyponatremia, largely related to cerebral dysfunction, can include severe signs like altered mental status and seizures.. We reviewed the literature dealing with altered mental status or seizures in enuretic subjects on desmopressin. The retained publications included patients who were described individually, revealing data on mode of administration, further identifiable factors predisposing to hyponatremia, presentation and clinical course.. We found 54 cases of hyponatremia secondary to desmopressin treatment presenting with altered mental status or seizures. In most cases the complication developed 14 days or less after starting desmopressin. An intranasal formulation had been used in 47 patients. Excess fluid intake was documented as a contributing factor in at least 22 cases. In 6 cases severe signs of hyponatremia developed in the context of intercurrent illnesses.. Altered mental status or seizures are very rare but recognized complications of desmopressin in enuresis. This complication mostly develops in subjects managed with the intranasal formulation 14 days or less after starting the medication, following excess fluid intake and during intercurrent illnesses.

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Lethargy; Seizures; Severity of Illness Index

Hypothermia has been demonstrated to induce pancytopenia in animals, but whether this association exists in humans is unknown. The authors report the case of an 8-year-old girl in whom hypothermia (temperature 33 degrees C-35 degrees C) is the cause of pancytopenia. The patient developed thermoregulatory dysfunction subsequent to surgical resection of a craniopharyngioma. Her recurrent cytopenias could not be explained by any etiology except chronic hypothermia. The pancytopenia improved upon rewarming the patient to a temperature of 36 degrees C. This association between hypothermia and pancytopenia has rarely been reported in humans and may be underdiagnosed especially in cases of transient or milder presentations. The authors recommend careful hematologic monitoring of patients with thermoregulatory dysfunction.

Topics: Adrenal Insufficiency; Blood Cell Count; Cerebral Infarction; Child; Chronic Disease; Consciousness Disorders; Craniopharyngioma; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Female; Frontal Lobe; Humans; Hyponatremia; Hypophysectomy; Hypopituitarism; Hypothalamus; Hypothermia; Hypothyroidism; Pancreatitis; Pancytopenia; Pituitary Neoplasms; Postoperative Complications; Seizures; Sleep Stages

A literature search revealed 23 studies that have reported on the type or frequency of side effects or complications associated with the use of desmopressin (DDAVP, Rhône-Poulenc Rorer Pharmaceuticals Inc, Collegeville, Pennsylvania) for the treatment of enuresis. Thirty-one (4.3%) side effects were reported in 717 patients. Seizure secondary to water intoxication is a potential complication of treatment with desmopressin and was reported in six patients, usually in association with excess fluid intake during the evening or day preceding the use of desmopressin. Desmopressin appears to have a favorable safety profile. Patients should be specifically instructed not to ingest excess fluids during the evening prior to administration of desmopressin.

Topics: Clinical Trials as Topic; Deamino Arginine Vasopressin; Drinking; Enuresis; Humans; Meta-Analysis as Topic; Seizures; Water Intoxication

Bowel preparation prior to colonoscopic examination is generally considered a safe process. Hyponatremia is a complication that has been reported in literature during bowel preparation. Individuals who develop severe symptomatic hyponatremia are often older and have comorbidities such as hypothyroidism, chronic kidney disease, or adrenal insufficiency. However, other mechanisms and circumstances can also lead to this potentially fatal complication.. We present a unique case of a patient who developed seizure prior to colonoscopy due to acute hyponatremia without any well-known risk factors. With the subsequent diagnosis of water intoxication, the use of desmopressin was believed to have contributed to this serious complication.. In addition to the use of certain well-documented medications and the presence of comorbidities that can lead to hyponatremia, clinicians should also be aware of the use of desmopressin as an important risk factor. Thorough history taking can guide individualized bowel preparation regimens to minimize the risk of undesired complications.

Topics: Colonoscopy; Deamino Arginine Vasopressin; Humans; Hyponatremia; Seizures; Water Intoxication

Topics: Accidents, Traffic; Arm Injuries; Deamino Arginine Vasopressin; Electroencephalography; Hematoma; Hemorrhage; Hemostatics; Humans; Hyponatremia; Male; Middle Aged; Multiple Trauma; Nasal Bone; Saline Solution, Hypertonic; Seizures; Skull Fractures; von Willebrand Diseases

A 7-year-8-month-old boy with cardiofaciocutaneous syndrome caused by the D638E mutation of the B-Raf proto-oncogene (BRAF) presented with new-onset seizures. He was incidentally found to have advanced Tanner staging on physical examination. Hormonal testing revealed pubertal levels of gonadotropins and sex steroid hormones. On brain imaging, a lack of visualisation of the posterior pituitary bright spot was observed, in addition to mild thinning of the corpus callosum and the lateral gyri of the cerebellar hemispheres. A diagnosis of idiopathic central precocious puberty was made and the patient was started on leuprolide depot treatment. Pituitary hormone testing revealed hyperprolactinemia for which the patient did not receive treatment as he was asymptomatic. During a subsequent hospital admission for seizures, the patient was diagnosed with transient central diabetes insipidus for which he required treatment with a desmopressin infusion.

Topics: Antineoplastic Agents, Hormonal; Child; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Ectodermal Dysplasia; Facies; Failure to Thrive; Heart Defects, Congenital; Hemostatics; Humans; Leuprolide; Male; Proto-Oncogene Mas; Proto-Oncogene Proteins B-raf; Puberty, Precocious; Seizures; Treatment Outcome

Exercise-associated hyponatraemia (EAH) always involves a component of overhydration relative to available exchangeable sodium stores. In the majority of cases, this is purely due to excessive consumption of fluids during exercise. In a lesser number of cases, it is apparent that excessive sodium loss through sweat may play a role by decreasing the amount of acutely available exchangeable sodium. Two cases demonstrating the latter, one in an individual with cystic fibrosis (CF) and another in an endurance athlete without CF, demonstrate how elevated dermal sweat losses may contribute to a

Topics: Adult; Aftercare; Anticonvulsants; Antidiuretic Agents; Confusion; Cystic Fibrosis; Deamino Arginine Vasopressin; Diagnosis, Differential; Exercise; Female; Heat Exhaustion; Hospitalization; Humans; Hyponatremia; Iontophoresis; Lorazepam; Male; Nausea; Osmolar Concentration; Seizures; Sodium; Sweat; Treatment Outcome

Topics: Administration, Intranasal; Contusions; Deamino Arginine Vasopressin; Female; Humans; Hyponatremia; Middle Aged; Seizures; Tongue

Topics: Aged; Deamino Arginine Vasopressin; Diuresis; Dose-Response Relationship, Drug; Drinking; Elective Surgical Procedures; Female; Health Personnel; Humans; Hyperparathyroidism, Primary; Hyponatremia; Parathyroidectomy; Postoperative Complications; Seizures; von Willebrand Diseases

Topics: Adult; Deamino Arginine Vasopressin; Female; Hemostatics; Humans; Hyponatremia; Seizures; von Willebrand Diseases

Topics: Blood Coagulation Disorders; Deamino Arginine Vasopressin; Female; Hemostatics; Humans; Hyponatremia; Middle Aged; Seizures

Enuresis nocturna is regularly treated by desmopressin, a vasopressin analog. Its side effects, notably neurological, are fortunately rare. We comment on 5 enuretic children on desmopressin who suffered from hyponatremic encephalopathy (natremia 115-127, median 117 mmol/l).. Side effects appeared at therapeutic doses (10-40 mg/d intranasal). An excessive fluid intake at night was often noted, leading to a dilutional hyponatremia. This may be due to a lack of correct information to the parents. These children presented after a period of warning symptoms, such as headache, vomiting and altered consciousness. Parents could have sought earlier medical attention if they had been informed about these symptoms.. In the absence of fluid restriction, severe hyponatremia can occur in enuretic children on desmopressin. It is therefore mandatory for the prescribing doctor to adequately inform patients and parents to limit fluids at night when desmopressin is used, and seek medical help quickly if any sign of intracranial hypertension appears.

Topics: Administration, Intranasal; Antidiuretic Agents; Child; Child, Preschool; Coma; Confusion; Deamino Arginine Vasopressin; Drinking; Enuresis; Female; Glasgow Coma Scale; Humans; Hyponatremia; Intracranial Hypertension; Male; Seizures; Time Factors

Topics: Adult; Anticonvulsants; Antidiuretic Agents; Brain; Brain Edema; Craniocerebral Trauma; Craniotomy; Deamino Arginine Vasopressin; Diazepam; Fatal Outcome; Hematoma, Subdural; Humans; Hyponatremia; Intubation, Intratracheal; Male; Nocturnal Enuresis; Phenytoin; Saline Solution, Hypertonic; Seizures; Sodium; Tomography, X-Ray Computed

Desmopressin (DDAVP) is used to improve hemostasis in patients with bleeding disorders. The side effects of DDAVP in adults and children are benign. However, there has been concern regarding the development of hyponatremia and seizures after the use of DDAVP in young children. The authors describe three children under 3 years of age who developed hyponatremia (two also developed seizures) following intravenous administration of DDAVP at a standard dose of 0.3 mug/kg. Fluid restriction, avoidance of hypo-osmolar fluid, and close monitoring of fluid and electrolytes for 12 to 24 hours after the administration of DDAVP in children younger than 3 years of age is recommended.

Topics: Child, Preschool; Deamino Arginine Vasopressin; Female; Hemorrhage; Hemostatics; Humans; Hyponatremia; Infant; Male; Seizures; Treatment Outcome

Topics: Adenoidectomy; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Fluid Therapy; Hemophilia A; Humans; Hyponatremia; Postoperative Care; Postoperative Complications; Renal Agents; Seizures; Tonsillectomy; Water Intoxication

Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. In all patients in whom DI occurred during or after surgery, a continuous intravenous infusion of aqueous vasopressin was initiated and titrated until antidiuresis was established. Intravenous fluids were given as normal saline and restricted to two thirds of the estimated maintenance rate plus amounts necessary to replace blood losses and maintain hemodynamic stability. In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.

Topics: Adolescent; Child; Child, Preschool; Clinical Protocols; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyponatremia; Hypotonic Solutions; Infusions, Intravenous; Male; Neurosurgical Procedures; Perioperative Care; Postoperative Complications; Prospective Studies; Renal Agents; Seizures; Sodium; Vasopressins; Water-Electrolyte Balance

Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. In all patients in whom DI occurred during or after surgery, a continuous intravenous infusion of aqueous vasopressin was initiated and titrated until antidiuresis was established. Intravenous fluids were given as normal saline and restricted to two thirds of the estimated maintenance rate plus amounts necessary to replace blood losses and maintain hemodynamic stability. In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.

Topics: Adolescent; Child; Child, Preschool; Clinical Protocols; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyponatremia; Hypotonic Solutions; Infusions, Intravenous; Male; Neurosurgical Procedures; Perioperative Care; Postoperative Complications; Prospective Studies; Renal Agents; Seizures; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Antidiuretic Agents; Child; Coma; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Hyponatremia; Seizures

Topics: Carcinoma, Papillary; Carcinoma, Renal Cell; Deamino Arginine Vasopressin; Female; Hemorrhagic Disorders; Humans; Hyponatremia; Kidney Neoplasms; Laparoscopy; Middle Aged; Neoplasms, Multiple Primary; Nephrectomy; Postoperative Complications; Seizures; Thyroid Neoplasms; Thyroidectomy; von Willebrand Diseases

Desmopressin, a synthetic analogue of the antidiuretic hormone, is an effective medication for primary nocturnal enuresis for both children and adults. Its safety is well established. Although it has a favorable side effect profile, because of its pharmacological effect, intranasal desmopressin can rarely induce water intoxication with profound hyponatremia if given without adequate restriction of water intake. The authors describe an adult patient with water intoxication and severe hyponatremia accompanied by loss of consciousness and seizures after 2-day intranasal administration of desmopressin. The present and the previously reported cases emphasize the need for greater awareness of the development of this serious and potentiallyfatal complication. In addition, to adjust the drug to the lowest required dosage, adequate restriction of water intake is recommended, and serum levels of sodium should be measured periodically to allow for early detection of water intoxication and hyponatremia.

Topics: Administration, Intranasal; Adult; Coma; Deamino Arginine Vasopressin; Drinking; Enuresis; Female; Humans; Hyponatremia; Seizures; Water Intoxication

Topics: Adult; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Intellectual Disability; Male; Renal Agents; Seizures

We report the cases of two children with cranial diabetes insipidus who were treated with lamotrigine for seizures and who had accompanying changes in desmopressin requirements. Lamotrigine is a new anticonvulsant chemically unrelated to other existing antiepileptic drugs. Studies suggest it acts at voltage-sensitive sodium channels and also decreases calcium conductance. Both of these mechanisms of action are shared by carbamazepine, which can cause hyponatraemia secondary to inappropriate secretion of antidiuretic hormone. It is possible that the effect of lamotrigine on fluid balance in the cases described is also centrally mediated.

Topics: Adolescent; Anticonvulsants; Child; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Dose-Response Relationship, Drug; Female; Humans; Hyponatremia; Hypopituitarism; Lamotrigine; Seizures; Triazines

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male; Renal Agents; Seizures

The case of a 6 year old child who presented with convulsions and coma after unsupervised self administration of intranasal desmopressin (DDAVP) for nocturnal enuresis is presented. Children with enuresis can be embarassed by their condition and may believe that multiple doses of their nasal spray may bring about a rapid resolution. Water intoxication is an uncommon but serious adverse effect of treatment with intranasal DDAVP. These patients may present with seizure, mental state changes, or both. Basic management consists of stopping the drug, fluid restriction, and suppressive treatment for seizures. Recovery is usually rapid and complete. Administration of the nasal spray in children should be supervised by parents to prevent highly motivated children from accidental overdose. The risks of high fluid intake need to be carefully explained to both parents and children.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male; Renal Agents; Seizures

Desmopressin (DDAVP) may be used to augment the action of factor VIII in mild haemophilia. Its use has been associated with serious adverse effects. We report a case of a three-year-old child with a family history of haemophilia who suffered complications due to severe acute hyponatraemia following the administration of this drug for post-tonsillectomy bleeding.

Topics: Adenoidectomy; Apnea; Blood Loss, Surgical; Child, Preschool; Deamino Arginine Vasopressin; Factor VIII; Hemophilia A; Hemostasis, Surgical; Hemostatics; Humans; Hyponatremia; Male; Postoperative Hemorrhage; Seizures; Tonsillectomy

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male; Renal Agents; Seizures

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male; Renal Agents; Seizures

Topics: Child; Coma; Deamino Arginine Vasopressin; Drug Therapy, Combination; Enuresis; Humans; Hyponatremia; Male; Seizures

Subcutaneously (s.c.) administered [Arg8]vasopressin (AVP) potentiated seizures induced by intracerebroventricular (i.c.v.) injection of 1.95 mg pilocarpine (a muscarinic cholinergic agonist). A bell-shaped relation between dose and effect was found. I.c.v. pretreatment with a V1, V2 or oxytocin receptor antagonist was performed to determine whether and what type of receptor is involved in this proconvulsive effect of vasopressin. For these experiments a higher dose of pilocarpine (2.4 mg i.c.v.) was injected. This caused seizures in a slightly but not significantly higher percentage of the rats. A dose-dependent protective action of the V2 receptor antagonist d(CH2),[D-Ile2,Ile4]AVP (effective doses were 25 and 125 ng) on seizures was found. A reduction was observed in the number of animals that developed tonic-clonic convulsions. Neither the V1 receptor antagonist d(CH2)5[Tyr(Me)2]AVP nor the oxytocin receptor antagonist desGly(NH2)9d(CH2)5[Tyr(Me)2Thr4]OVT possessed anti-convulsive activity. Subsequently the type of receptor was studied in detail with fragments of AVP with either V1 or V2 activity. AVP (with V1 and V2 affinity) (1 and 3 microg s.c.) potentiated pilocarpine (1.95 mg) induced seizures. Vasotocin and oxytocin were without effect. Interestingly neither s.c. nor i.c.v. administration of the selective kidney type vasopressin receptor (V2) agonist dDAVP potentiated pilocarpine induced seizures. Several selective antidiuretic agonists (V2), such as d[Val4]AVP, d[Phe2,Val4,D-Arg8]vasopressin (3 microg), [Val4,D-Arg8]vasopressin (3 microg) and d[Val4,D-Arg8]vasopressin (3 microg) were active. Other selective antidiuretic compounds, such as [Val4]AVP, dAVP, d[Tyr(Me)2]AVP and HO[D-Arg8]vasopressin (3 microg) did not influence seizures. These results demonstrate that a combination of substitution of aminoacid 4 (Gln) by Val and to a lesser extent deamination and the D-arginine form yield an active molecule, which can potentiate pilocarpine induced seizures and suggest the existence of a V2 receptor subtype in the brain.

Topics: Animals; Antidiuretic Hormone Receptor Antagonists; Arginine Vasopressin; Brain; Deamino Arginine Vasopressin; Drug Synergism; Injections, Intraventricular; Male; Muscarinic Agonists; Oxytocin; Peptide Fragments; Pilocarpine; Rats; Rats, Wistar; Receptors, Oxytocin; Receptors, Vasopressin; Seizures; Vasotocin

Topics: Administration, Intranasal; Child, Preschool; Deamino Arginine Vasopressin; Female; Humans; Hyponatremia; Seizures

Topics: Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Hyponatremia; Infant; Infant, Newborn; Male; Renal Agents; Seizures; Water Intoxication

Desmopressin (DDAVP) is frequently used in the treatment of primary isolated enuresis nocturna if other approaches have failed. We report a further case of hyponatraemia and cerebral convulsion due to water intoxication after intranasal DDAVP application by a 6 year-old boy with enuresis.. Although adverse reactions in DDAVP (e.g. hyponatraemia) are rare, it should not be considered as the first choice treatment of enuresis nocturna and only be used with caution.

Topics: Child; Deamino Arginine Vasopressin; Diseases in Twins; Enuresis; Humans; Hyponatremia; Male; Renal Agents; Seizures; Water Intoxication

Topics: Child; Deamino Arginine Vasopressin; Humans; Hyponatremia; Imipramine; Male; Seizures

Topics: Child; Deamino Arginine Vasopressin; Drinking; Electrolytes; Enuresis; Humans; Hyponatremia; Male; Osmolar Concentration; Seizures; Water Intoxication

Topics: Administration, Intranasal; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Humans; Hyponatremia; Male; Seizures

Topics: Celiac Disease; Congenital Hypothyroidism; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hyponatremia; Hypothyroidism; Infant; Male; Seizures

Topics: Child; Deamino Arginine Vasopressin; Female; Hemostasis, Surgical; Humans; Hyponatremia; Infant; Injections, Intravenous; Male; Osmolar Concentration; Seizures; Time Factors

Topics: Administration, Intranasal; Adolescent; Coma; Cystic Fibrosis; Deamino Arginine Vasopressin; Female; Humans; Seizures