deamino-arginine-vasopressin and Shock

Treatment with desmopressin diacetate arginine vasopressin (DDAVP) and its withdrawal are associated with side effects. We present a rare case of severe biphasic adverse reactions induced by DDAVP and its withdrawal in a 63-year-old female patient. A lump in the left axillary region was biopsied, and she received DDAVP after surgery. The following day, she lost consciousness, with foaming at the mouth and seizures. Hypotonic encephalopathy was considered. DDAVP was ceased, and she received electrolytes. On day 1, she displayed low blood pressure and increased urine output. She received DDAVP and dopamine as well as electrolytes. The patient was ambulatory on day 7 and was discharged without brain abnormalities on MRI. In conclusion, severe hyponatremia induced by DDAVP and massive polyuria and hypovolemic shock induced by DDAVP withdrawal are life-threatening conditions. This case underlines the need to be vigilant when administering DDAVP and to monitor for any side effects.

Topics: Deamino Arginine Vasopressin; Female; Humans; Hyponatremia; Middle Aged; Polyuria; Shock

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.

Topics: Antidiuretic Agents; Brain Injuries; Coronavirus Infections; COVID-19; Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Disease Management; Fluid Therapy; Humans; Hypernatremia; Hyponatremia; Hypotonic Solutions; Inappropriate ADH Syndrome; Neurosurgical Procedures; Pandemics; Pneumonia, Viral; Postoperative Complications; Practice Guidelines as Topic; Saline Solution; Shock

Topics: Aminocaproic Acid; Blood Transfusion; Deamino Arginine Vasopressin; Edema; Factor VII Deficiency; Factor VIIa; Hemostatics; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Postoperative Hemorrhage; Recombinant Proteins; Shock; Tooth Extraction; Vitamin K

Topics: Adult; Aminocaproic Acid; Antiphospholipid Syndrome; Aprotinin; Blood Coagulation Tests; Blood Loss, Surgical; Combined Modality Therapy; Contraindications; Crystalloid Solutions; Deamino Arginine Vasopressin; Disseminated Intravascular Coagulation; Erythrocyte Transfusion; Factor VII; Factor VIIa; Female; Fluid Therapy; Hemorrhage; Hemostatics; Humans; Isotonic Solutions; Lupus Coagulation Inhibitor; Plasma; Platelet Transfusion; Pressure; Recombinant Proteins; Retroperitoneal Neoplasms; Shock; Thrombophlebitis; Tranexamic Acid