deamino-arginine-vasopressin and Spinal-Cord-Injuries

The aim of this study is to evaluate the use of desmopressin acetate (DDAVP) in the management of nocturnal enuresis in patients with spinal cord injury (SCI), as well as arginine vasopressin (AVP) daily production, urine output, urine osmolarity and clean intermittent catheterization (CIC) before and after the use of desmopressin.. We studied 11 patients with SCI (7 men 4 women). All patients attended a rehabilitation program and used a wheelchair for locomotion. To improve bladder function and achieve socially acceptable continence all patients were placed on a regimen of anticholinergic drugs (oxybutynin 5 mg, 1x3 daily), evening antibiotic prophylaxis and CIC. The subjects were also on night CIC in order to avoid nocturnal incontinence. DDAVP was given intranasally (20 mg before bedtime) in association with other standard therapy. Urine samples were collected under sterile conditions from all patients at 6:00 a.m. and 6:00 p.m. Urine volume was measured and the amount of urine per hour was calculated. Blood samples were also taken to measure serum AVP, urea, creatinine and serum electrolyte.. Our data suggest that nocturnal polyuria in SCI patients occurs due to a lack of diurnal variation of antidiuretic hormone (ADH) secretion. The use of desmopressin produced a statistically significant increase in urine production rate during the day (56.2 vs 81.2 mL/h, P<0.001) and a decrease in nocturnal urine production (59.2 vs 27.7 mL/h, P<0.001). Desmopressin treatment reflects also on urine osmolarity, which did not change during the day (496 vs 489 mOsm/mL, P>0.5) but showed a significant increase during the night (385 vs 862 mOsm/mL, P<0.001). There was a significant decrease in night CIC. No serious adverse effects were observed.. Our results suggest that desmopressin administration is an beneficial treating option for patients with SCI when fluid restriction and other preventive measures are not able to control abnormal nocturnal polyuria.

Topics: Adult; Antidiuretic Agents; Arginine Vasopressin; Deamino Arginine Vasopressin; Female; Humans; Male; Nocturnal Enuresis; Osmolar Concentration; Spinal Cord Injuries; Treatment Outcome; Urinary Catheterization; Urine

To test the effectiveness of desmopressin in decreasing operative blood loss in major flap reconstructions, 44 hemostatically normal patients with spinal cord injury and pelvic pressure sores participated in a randomized, prospective, double-blind clinical trial. Each patient received a single dose of desmopressin (0.3 micrograms/kg) or saline placebo intravenously at the initiation of a reconstructive surgical procedure. Preoperative and postoperative hemoglobin, hematocrit, von Willebrand factor, and factor VIII determinations and measurement of intraoperative blood loss and transfusions of packed red cells were recorded. Desmopressin-treated patients experienced a smaller decline in hemoglobin and hematocrit levels postoperatively. In those patients requiring major flap reconstructions, the use of desmopressin significantly decreased intraoperative blood loss and subsequent transfusion requirements. The levels of von Willebrand factor and factor VIII tended to be higher, although not significantly so, in subjects receiving desmopressin. No patient experienced an adverse reaction to the drug. We conclude that a single dose of desmopressin, given immediately preoperatively, is safe and effectively decreases blood loss and transfusion requirements in patients undergoing major flap reconstructive surgery.

Topics: Blood Coagulation; Blood Loss, Surgical; Deamino Arginine Vasopressin; Double-Blind Method; Humans; Pelvis; Pressure Ulcer; Prospective Studies; Spinal Cord Injuries; Surgical Flaps

Activity-based recovery training (ABRT) reverses spinal cord injury (SCI) induced polyuria and alterations of biomarkers involved with fluid balance, including expression levels of kidney vasopressin 2 receptors. However, void volumes do not return to pre-injury baseline levels, indicating a combinatorial approach may be necessary.. In the current study, acute effects of a pharmacological intervention versus placebo were examined in male rats that had received 70 daily ABRT sessions. The treatment, desmopressin (DDAVP - synthetic analogue of arginine vasopressin), an antidiuretic therapy used for the management of bedwetting in children and central diabetes insipidus, has previously shown some promise in a few limited cohorts of SCI individuals having nocturnal polyuria.. A total of 70 sessions of ABRT over a 10-week timeframe again reduced the overproduction of urine, but not completely to pre-SCI baseline levels. DDAVP treatment maintained but did not further reduce the level of urine output in the ABRT group without continuous exercise, demonstrating either intervention/treatment alone is effective, despite no additive effect. Although intake did not change from pre-injury levels despite polyuria, DDAVP treatment also reduced drink volume.. Further studies are needed as the mechanisms underlying changes in fluid and solute balance are likely multi-factorial involving a complex interaction between the neural (both central and peripheral) control of systems mediating thirst, urinary output, and cardiovascular regulation.

Topics: Animals; Child; Deamino Arginine Vasopressin; Humans; Male; Polyuria; Rats; Rats, Wistar; Spinal Cord Injuries; Urination

Chick embryos are capable of functional spinal cord regeneration following crush injury until embryonic day 13. Developmental changes occurring thereafter result in failure to regenerate. Secondary injury mechanisms can result in apoptotic cell death and make a major contribution to cell loss after trauma. We report here that around embryonic day 13 there is a dramatic increase in blood vessel numbers in the spinal cord, and that the extent of hemorrhage in response to injury increases with developmental age. This is paralleled by increased apoptosis and subsequent cavitation in spinal cords injured at embryonic day 15 as compared with embryonic day 11. Following spinal cord injury at embryonic day 15, apoptotic cell death is extensive and spreads to the same extent as the hemorrhage. When hemorrhage is reduced by treatment with the hemostatic drug desmopressin the extent of apoptosis and cavity formation in spinal cords injured at embryonic day 15 decreases. Furthermore, manipulations of embryonic day 11 spinal cords that increase hemorrhage also increase apoptosis and result in cavitation in contrast to the effective repair typical of this stage. Altogether these results suggest that cavity formation occurring at developmental stages non-permissive for regeneration is largely due to changes in the extent of apoptosis that are related to vascularization and hemorrhage.

Topics: Animals; Apoptosis; Chick Embryo; Deamino Arginine Vasopressin; Embryonic Development; Hemorrhage; Immunohistochemistry; In Situ Nick-End Labeling; Neovascularization, Pathologic; Nerve Regeneration; Reverse Transcriptase Polymerase Chain Reaction; Spinal Cord; Spinal Cord Injuries

Case report.. To present a case of central diabetes insipidus (CDI) that developed after a gunshot injury to the thorax and thoracic spinal cord and to discuss the disease process in light of the relevant literature.. Antidiuretic hormone (ADH) abnormalities may develop after spinal trauma and/or surgery. Although there are published reports of inappropriate ADH syndrome arising in this clinical picture, CDI is rare.. A 33-year-old woman with hemopneumothorax and a gunshot wound to her thoracic spine was treated with chest tube drainage. No surgery was performed for the spinal injury. The patient was paraplegic on admission and rapidly developed excessive urine output. Testing revealed that her serum ADH level was low, consistent with CDI. Desmopressin acetate nasal spray was the prescribed treatment.. The patient responded well to the desmopressin acetate spray.. CDI is a complicated hormonal disorder characterized by excessive urine output. It is typically linked to an abnormality in the hypothalamohypophyseal axis that markedly reduces ADH production. The most common inciting causes are craniocerebral trauma, brain tumor and/or surgery, and central nervous system infection. Although uncommon, CDI should be considered when a spinal trauma patient develops excessive urine output.

Topics: Administration, Intranasal; Adult; Atrophy; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Female; Hemostatics; Humans; Magnetic Resonance Imaging; Spinal Cord; Spinal Cord Injuries; Thoracic Injuries; Thoracic Vertebrae; Thorax; Treatment Outcome; Wounds, Gunshot

The purpose of this study is to determine the efficacy of desmopressin (DDAVP), a synthetic analogue of antidiuretic hormone, as an alternative therapy in the management of spinal cord injured (SCI) patients with neurogenic bladder dysfunction unresponsive to conventional therapy. Seven SCI patients (three men and four women) were treated with DDAVP after urodynamic evaluation. Despite treatment with anticholinergic agents, urodynamic evaluation demonstrated uninhibited detrusor contractions exceeding 30 cm H2O pressure at less than 300 ml cystometric capacity in all seven patients. Three patients had been managed with intermittent self-catheterization, but had socially unacceptable short intervals between catheterizations. Two women with incomplete injury were afflicted with significant nocturia (> 3 episodes/night). The remaining two patients managed with intermittent self-catheterization were troubled with nocturnal enuresis. The patients received 10 micrograms intranasal DDAVP once every 24 hours. Prior to DDAVP administration, the four patients who used DDAVP nightly experienced a median of four episodes of nocturia. After one month of DDAVP treatment, two patients had only one episode of nocturia per night and in the other two patients, nocturnal enuresis was completely eliminated. Three patients used daytime DDAVP administration at work to avoid frequent catheterization. The median period between bladder catheterizations increased from 2.5 hours before DDAVP to 6 hours while using DDAVP. Symptomatic improvement persisted during the follow-up period of 6-20 months (mean = 12). Side effects were infrequent; only one patient complained of transient headaches. Neither hyponatremia nor serum electrolyte abnormalities occurred. Our preliminary results suggest that DDAVP is safe and effective in the symptomatic management of complicated neurogenic bladder dysfunction in selected SCI patients.

Topics: Administration, Intranasal; Adult; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Drug Administration Schedule; Enuresis; Female; Humans; Male; Middle Aged; Spinal Cord Injuries; Urinary Bladder, Neurogenic; Urodynamics