Reactions 701 - 16 May 1998

SDesmopressin

Hyponatraemia and seizure in a child followingintranasal administration: case report

A 10-year-old boy developed hyponatraemia associatedwith a generalised tonic-clonic seizure during treatment withintranasal desmopressin for nocturnal enuresis.

The boy started treatment with intranasal desmopressin 40µg/night. Approximately 3 weeks later, he experienced nauseaand emesis. At the time, streptococcal pharyngitis wasdiagnosed and he was prescribed cefadroxil. The followingmorning, he vomited and then had a brief, generalised tonic-clonic seizure.

The boy was taken to an emergency department. He wasdrowsy and he had mild dysarthria and intermittent myoclonicjerking of his hands. He was admitted to an intensive care unitand his fluid intake was restricted. However, his serum sodiumlevel decreased from 121 to 117 mmol/L 3 hours after initialpresentation. He was treated with IV isotonic saline with 5%dextrose and his serum sodium level increased to 131 mmol/Lafter approximately 15 hours. IV fluids were then stopped andhe was allowed to eat. His dysarthria and myoclonic jerksresolved and, by the time of discharge, his serum sodium levelhad increased to 134 mmol/L. He did not continue to usedesmopressin and, at follow-up after some months, he had notexperienced any further seizures.

Author comment: This case is unique because the boy didnot have a history of excessive fluid intake, he had no signs ofhypervolaemia < 24 hours prior to the seizure and hismedication was apparently administered correctly. Theepisodes of vomiting that he experienced initially were possiblysymptoms of altered fluid balance rather than sequelae of hisstreptococcal infection.Donoghue MB, et al. Hyponatremic seizure in a child using desmopressin fornocturnal enuresis. Archives of Pediatrics and Adolescent Medicine 152: 290-292,Mar 1998 - USA 800668859

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Reactions 16 May 1998 No. 7010114-9954/10/0701-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved