deamino-arginine-vasopressin and Water-Intoxication

DDAVP is a drug that should be used with caution for each patient individually. Particular care is needed to avoid fluid overload and rapid fluctuations in sodium concentration. Not only families but physicians as well should be educated and aware of the adverse effects of DDAVP, especially in high risk patients. Extreme caution is needed in children with severe neurological and developmental problems who cannot control their fluid intake themselves. Similarly, caution is needed in patients with hypodipsia and DI who have difficulty in balancing water intake and DDAVP dose. The treatment of DI is water; however, DDAVP is given to avoid a large fluid intake which can result in medullary washout. Frequent home monitoring of body weight and regular determinations of serum sodium may help to disclose the early phase of over-hydration or dehydration. DDAVP therapy should be temporarily interrupted during acute illness, febrile episodes, hot days and other conditions with increased water intake. It should be used with considerable caution in patients with cystic fibrosis, or renal or cardiovascular diseases. In patients with enuresis, it is recommended that DDAVP medication should not be continued for longer than 3 months without stopping for 1 week for full reassessment. Fluid intake should be limited 1 hour before and 8 hours after the dose. Generally, undertreatment with vasopressin analogue is safer than overtreatment. A simple measure to avoid overtreatment is to miss one dose once a week; a rapid onset diuresis ('washout' effect) provides considerable reassurance.

Topics: Adolescent; Antidiuretic Agents; Brain Edema; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Enuresis; Hemostatics; Humans; Hyponatremia; Myelinolysis, Central Pontine; Sodium; Water Intoxication

Desmopressin is widely used in primary nocturnal enuresis, bleeding disorders, central diabetes insipidus and diagnostic urine concentration testing. Hyponatremic hypervolemia leading to seizures has been reported as a rare but potentially life threatening side effect of desmopressin therapy. We sought to identify factors that predispose patients to hyponatremia and to find predictive factors associated with increased risk of water intoxication.. We report 13 novel cases of desmopressin associated water intoxication and review the literature. A total of 93 instances of symptomatic hyponatremia during desmopressin treatment in children were identified. Specific data were reported in 58 of 93 cases. These 58 cases, in addition to our 13 novel cases, were further analyzed.. All children were treated with intranasal or intravenous desmopressin. No patient received oral desmopressin. Younger children are at greater risk for water intoxication than older children. The risk is particularly high at the beginning of desmopressin therapy. A total of 45 patients (63%) had prodromal symptoms, eg nausea, vomiting and headache. In 10 cases (14%) desmopressin was prescribed without an evident need.. Based on this analysis, we conclude that the use of desmopressin should be cautiously considered, careful monitoring should be performed during the initiation of therapy, and particular care should be taken when treating young children and when prodromal symptoms such as nausea, vomiting and headaches occur.

Topics: Adolescent; Child; Child, Preschool; Deamino Arginine Vasopressin; Female; Humans; Hyponatremia; Hypovolemia; Male; Renal Agents; Water Intoxication

We present a case of a 29-year-old woman with a long history of nocturnal enuresis who developed symptomatic hyponatremia from water intoxication shortly after beginning desmopressin. A MEDLINE search in the English language revealed 13 prior case reports. All patients presented with seizure, mental status changes, or both. Two distinct presentations occurred: one group of patients maintained a stable course with desmopressin and developed symptoms related to an outside factor. The other group of patients were new to desmopressin and had a profound water intoxication response from its use. While the underlying cause was from simple overhydration, the quickness of this unanticipated adverse effect is noteworthy. The importance of counseling to ensure a family's and a patient's understanding of the effects of desmopressin as well as monitoring electrolytes periodically may help identify and prevent this serious iatrogenic complication.

Topics: Administration, Intranasal; Adolescent; Adult; Child; Child, Preschool; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Hyponatremia; Infant; Male; Renal Agents; Water Intoxication

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

A 32 year old I P II G with preexisting diabetes insipidus was treated with 1-(3-mercaptopropionic acid)-8-d-arginine vasopressin (DDAVP) during pregnancy. An otherwise normal pregnancy was marked only with an excessive weight increase. A healthy girl was delivered by secondary cesarean section at term. Postoperative the mother developed a water intoxication accompanying oxytocin-infusion. During nursing the diabetes insipidus improved significantly whereby DDAVP doses could be reduced to 20-10 percent. We suppose an overreaction to endogene oxytocin with an antidiuretic effect.

Topics: Administration, Intranasal; Cesarean Section; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Infant, Newborn; Oxytocin; Postoperative Complications; Pregnancy; Pregnancy Complications; Water Intoxication; Water-Electrolyte Balance

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

The most used experimental mouse model of hyponatremia and elevated intracranial pressure (ICP) is intraperitoneal injection of water in combination with antidiuretics. This model of water intoxication (WI) results in extreme pathological changes and death within 1 h. To improve preclinical studies of the pathophysiology of elevated ICP, we characterized diuresis, cardiovascular parameters, blood ionogram and effects of antidiuretics in this model. We subsequently developed a new mouse model with mild hyponatremia and sustained increased ICP. To investigate the classical protocol (severe WI), C57BL/6mice were anesthetized and received an intraperitoneal injection of 20% body weight of MilliQ water with or without 0.4 µg·kg

Topics: Animals; Antidiuretic Agents; Deamino Arginine Vasopressin; Disease Models, Animal; Hyponatremia; Injections, Intraperitoneal; Intracranial Hypertension; Intracranial Pressure; Male; Mice; Mice, Inbred C57BL; Water Intoxication

Induction of cellular cerebral edema (CE) was achieved by a standard method of water intoxication which consisted of fractionated intraperitoneal administration of distilled water (DW) together with the injection of desmopressin (DP). Using metabolic cage, fluid and food balance was studied in two groups of eight animals: group C - control; group CE - cellular edema induced by water intoxication. For each rat the intake (food pellets and water) and excretion (solid excrements and urine) were recorded for 48 h together with the initial and final body weight. CE animals consumed significantly less food, drank less water and eliminated the smallest amount of excrements. The induction of cellular cerebral edema was accompanied with a significant loss of body weight (representing on average 13 % of the initial values) mainly due to a reduction of food intake. This phenomenon has not yet been reported.

Topics: Animals; Antidiuretic Agents; Body Weight; Brain Edema; Deamino Arginine Vasopressin; Male; Rats; Rats, Wistar; Water Intoxication; Weight Loss

Dilutional hyponatremia, although not uncommon, is an underestimated problem in the pediatric population. In most cases, it results from excessive hydration or water retention, also described as the so-called water intoxication. One of the most known causes is the use of desmopressin in enuretic children. This drug enhances the free water reabsorption in the renal collecting ducts. The addition of the anticholinergic agent oxybutynin aggravated the condition by causing a dry mouth with excessive thirst and water intake in our first case. Dietary water overconsumption, either voluntary or involuntary, is a phenomenon seen in formula-fed babies. But in our second case, a game involving forced ingestion of large amounts of water had serious consequences including hyponatremia-related coma. An effort should therefore be made to inform caretakers about the risks of these games. These cases, provoked by rather unusual and peculiar causes, illustrate again that electrolytes and especially serum [Na(+)] are key points to be determined in a child with diminished consciousness. Moreover, an accurate history including the intake of medication and dietary information should be made.

Topics: Antidiuretic Agents; Child; Cholinergic Antagonists; Deamino Arginine Vasopressin; Drug Therapy, Combination; Electrocardiography; Female; Humans; Hyponatremia; Male; Mandelic Acids; Nocturnal Enuresis; Water Intoxication

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Humans; Nocturnal Enuresis; Water Intoxication

Desmopressin has been used extensively for primary nocturnal enuresis and it is associated with a low incidence of adverse effects. The only reported serious side effect is seizure or altered levels of consciousness resulting from water intoxication, which has been reported for the nasal spray. We describe 18 children with clinical symptoms of water intoxication due to the prolonged bioactivity of desmopressin nasal spray.. We evaluated 18 patients with clinical suspicion of prolonged desmopressin bioactivity during treatment with intranasal desmopressin for primary nocturnal enuresis. The control group consisted of 50 children with primary nocturnal enuresis and proven nocturnal polyuria who were treated with the same desmopressin regimen.. All patients had prolonged maximal urinary concentration capacity and delayed restoration of daytime diluting capacity (p <0.01). Of the patients 15 had the characteristic clinical symptoms of water intoxication with vomiting, headache, decreased consciousness and hyponatremia. We suspect that these symptoms are secondary to prolonged desmopressin bioactivity.. Prolonged desmopressin bioactivity may increase the risk of water intoxication.

Topics: Adolescent; Antidiuretic Agents; Child; Deamino Arginine Vasopressin; Enuresis; Female; Half-Life; Humans; Male; Prospective Studies; Time Factors; Water Intoxication

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

Topics: Administration, Intranasal; Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Hemostatics; Histiocytosis, Langerhans-Cell; Humans; Hyponatremia; Severity of Illness Index; Water Intoxication

Seven cases of cerebral oedema have been observed in enuretic children during low-dose desmopressin (DDAVP) treatment given in a dose of 7-21 microg daily in the Czech Republic between 1995 and 1999, after the drug started to be marketed for this indication and delivered in simple bottles with a dropper. All seven children (age 5-11 years, four boys) experienced a period of unconsciousness but all recovered without sequelae. In most cases, safety measures were underestimated and natraemia was not regularly controlled. Two children developed cerebral oedema after excessive water intake in preparation for uroflowmetry, another one drank much during a hot summer day, in one diabetes insipidus was not recognised and two children were clearly non-compliant with reduced fluid intake on a long-term basis. Only in one child, no risk factor was found. Conclusion. Proper selection and instruction of patients is needed to avert cerebral oedema during treatment with desmopressin for nocturnal enuresis.

Topics: Brain Edema; Child; Child, Preschool; Consumer Product Safety; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Hyponatremia; Male; Renal Agents; Water Intoxication

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: Child; Child Behavior Disorders; Deamino Arginine Vasopressin; Enuresis; Humans; Male; Renal Agents; Time Factors; Water Intoxication

Topics: Deamino Arginine Vasopressin; Dehydration; Diabetes Insipidus; Humans; Mutation; Receptors, Vasopressin; Renal Agents; Risk Factors; Water Intoxication

The paper describes a patient with Asperger disorder, Neurogenic Diabetes Insipidus (NDI) and Primary Empty Sella (ES). His response to vasopressin treatment suggested a concomitant presence of primary polydipsia. This is the first reported case of an autistic spectrum disorder associated with NDI or ES. The implications of the observed co-occurrence of these relatively rare disorders are discussed in relation to diagnosis and pathogenesis.

Topics: Adult; Autistic Disorder; Comorbidity; Deamino Arginine Vasopressin; Diabetes Insipidus; Drinking; Empty Sella Syndrome; Humans; Magnetic Resonance Imaging; Male; Pituitary Gland, Posterior; Syndrome; Water Intoxication

We report on a girl with the Prader-Willi syndrome who received desmopressin for nocturnal enuresis, and water intoxication developed after she ingested a large amount of fluid.. The patient received 10 mg. desmopressin at bedtime for enuresis. She was hospitalized when a major motor seizure and coma (Glasgow coma scale 8) occurred after ingesting 48 ounces of fluid. Treatment included 3% saline, followed by 5% dextrose in water and sodium chloride given intravenously.. Serum sodium increased to 128 mEq./l. and serum glucose remained normal. Computerized tomography and magnetic resonance imaging of the head were normal and revealed no evidence of cerebral pontine myelinosis. Patient consciousness returned to normal by day 5 after the seizure.. In patients treated with desmopressin the risk of a seizure or altered level of consciousness can be minimized by not ingesting large quantities of fluid. We recommend that patients drink no more than 8 ounces of fluid on any evening that desmopressin is administered.

Topics: Adolescent; Deamino Arginine Vasopressin; Enuresis; Female; Humans; Prader-Willi Syndrome; Renal Agents; Water Intoxication

Desmopressin is used for the treatment of nocturnal enuresis. Side effects reported with intranasal desmopressin are transient headache, nausea, abdominal cramps and water intoxication with hyponatremia and grand mal seizure. We report a case of water intoxication with low serum sodium and grand mal seizure in a healthy child treated for enuresis with desmopressin. The child experienced abdominal cramps and nausea prior to the convulsions. A computerised tomography scan of the brain gave the suspicion of increased intracranial pressure ICP. The child recovered fully. We therefore recommend that parents and child are fully informed about the administration and the risk of desmopressin. If a child on desmopressin treatment experiences abdominal cramps, nausea or headache the drug should be discontinued and a physician contacted for control of serum sodium. Temporary withdrawal of desmopressin should also be considered in cases of acute illness influencing water balance.

Topics: Acute Disease; Child; Deamino Arginine Vasopressin; Humans; Male; Renal Agents; Tomography, X-Ray Computed; Water Intoxication

Water intoxication is a serious condition which may be caused by desmopressin overdose, with reversible or irreversible neurological complications. In the past, desmopressin was used in endocrinological centers for the treatment of antidiuretic hormone deficiency (central diabetes insipidus). Indications for hormone treatment have since widened, especially as an effective solution for nocturnal enuresis. It is now often prescribed in community clinics, and its use has been encouraged by extensive promotion. We describe a 15-year-old boy with primary nocturnal enuresis who started treatment with desmopressin 1 year prior to admission. He was allowed to use the drug without supervision, and drank excessively. The result was water intoxication which required admission for intensive care because of loss of consciousness and convulsions for 36 hours.

Topics: Adolescent; Critical Care; Deamino Arginine Vasopressin; Drug Overdose; Enuresis; Humans; Male; Renal Agents; Water Intoxication

Topics: Acute Disease; Administration, Intranasal; Deamino Arginine Vasopressin; Humans; Renal Agents; Water Intoxication

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; Diagnosis, Differential; Drinking; Female; Humans; Water Intoxication

A 4-year-old boy was treated with oxybutinine and desmopressine because of bladder instability associated with secondary enuresis. He was admitted with obnubilation, vomiting and experienced two seizure episodes concomitantly with hyponatremia and hypoosmolality. The child healed promptly under water restriction and intravenous administration of sodium chloride. This case report suggests that desmopressine may be responsible for severe side-effects. This drug should not be widely used and its indications should be restricted to patients with proven antidiuretic hormone secretion abnormalities.

Topics: Child; Deamino Arginine Vasopressin; Enuresis; Humans; Male; Water Intoxication

We report a case of hyponatremia associated with a grand mal seizure in a 28 month-old child after intra-nasal desmopressin administration for high fluid intake with nocturnal enuresis. In view of the temporary symptomatic action and the seriousness of certain side-effects of desmopressin we recommend that desmopressin be used with caution in childhood enuresis.

Topics: Administration, Intranasal; Aerosols; Child, Preschool; Deamino Arginine Vasopressin; Drinking; Enuresis; Epilepsy, Tonic-Clonic; Humans; Hyponatremia; Male; Water Intoxication

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

Only a few cases of severe acute water intoxication (AWI) due to intranasal desmopressin have been reported, none of which occurred in patients with primary polydipsia. We describe a case of AWI with semicoma and convulsions, due to intranasal desmopressin, in a 32-year-old patient with dipsogenic diabetes insipidus. Previous reported cases of AWI due to desmopressin are discussed. The importance of ruling out primary polydipsia when this drug is used, not only for central diabetes insipidus but also for other current indications such as classic hemophilia, is stressed.

Topics: Administration, Intranasal; Adult; Deamino Arginine Vasopressin; Drinking; Female; Humans; Polyuria; Water Intoxication

Topics: Adenoma, Chromophobe; Deamino Arginine Vasopressin; Drug Administration Schedule; Humans; Hyponatremia; Male; Middle Aged; Pituitary Neoplasms; Postoperative Complications; Water Intoxication

A new rat model of the Schwartz--Bartter syndrome was created by the administration of 1-deamino-8-D-arginine vasopressin together with a forced water intake. The treatment led to water retention, hypernatriuria, marked hyponatraemia (in 4-5 days) and severe cerebral oedema. These changes could be prevented by the simultaneous administration of [1-(beta-mercapto-beta, beta-cyclopentamethylene-propionic acid)- 2-o-ethyltyrosine-4-valine] arginine vasopressin. The observations indicate that this vasopressin antagonist analogue might be of use in the future as an effective drug against the Schwartz--Bartter syndrome.

Topics: Animals; Arginine Vasopressin; Deamino Arginine Vasopressin; Disease Models, Animal; Inappropriate ADH Syndrome; Male; Rats; Vasopressins; Water Intoxication

Topics: Deamino Arginine Vasopressin; Diabetes Mellitus; Humans; Infant; Male; Water Intoxication

Topics: Administration, Intranasal; Arginine Vasopressin; Deamino Arginine Vasopressin; Female; Humans; Infant; Infant, Newborn; Kidney Concentrating Ability; Male; Water Intoxication

Topics: Adult; Arginine Vasopressin; Child; Deamino Arginine Vasopressin; Diabetes Insipidus; Dose-Response Relationship, Drug; Humans; Inappropriate ADH Syndrome; Male; Water Intoxication

Topics: Arginine Vasopressin; Deamino Arginine Vasopressin; Female; Humans; Iatrogenic Disease; Middle Aged; Psychophysiologic Disorders; Thirst; Water Intoxication

Topics: Adult; Deamino Arginine Vasopressin; Hemophilia A; Hemostasis, Surgical; Humans; Hyponatremia; Male; Tooth Extraction; Vasopressins; Water Intoxication

Topics: Adenylyl Cyclases; Animals; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Enzyme Activation; Fluorides; Glucose; Guanine Nucleotides; Heterozygote; Kidney; Lypressin; Male; Rats; Species Specificity; Vasopressins; Water Intoxication