Reactions 1154 - 2 Jun 2007

SDesmopressin

Water intoxication in children: 3 case reportsTwo children and one infant developed water intoxication

during treatment with desmopressin for diabetes insipidus(patients 1 and 2) and enuresis (patient 3).

Patient 1, an 1.5-month-old boy, who was in a paediatricICU with meningitis, developed diabetes insipidus withhypernatraemia (160 mmol/L), polyuria, a urine specific gravityof 1001 and an elevated blood osmolarity (330 mOsm/L) onday 13. He starting receiving intranasal desmopressin 5 µg/dayand then 5µg twice daily on days 14 and 15. His serum sodiumlevel suddenly decreased to 140 mmol/L and he had asignificant weight increase within 24 hours (8.2% of baselineweight). Desmopressin was stopped, but was subsequentlyrestarted at a dose of 0.5µg twice daily. At 1-year follow-up, hisdiabetes insipidus persisted and he required further treatmentwith desmopressin.

Patient 2, a 9-year-old girl, started receiving IVdesmopressin 0.25µg on day 1, followed by 1.15 µg/daydivided into three daily doses on day 2, and 1.4µg on day 3,due to persistent polyuria. On day 4, she started receivingintranasal vasopressin 10µg twice daily. On day 6, she hadconfusion due to hyponatraemia (121 mmol/L). She received anormal saline infusion and a diuretic and desmopressin wasstopped. Her clinical condition improved and her sodiumlevels progressively increased to 132 mmol/L on day 8.Subsequently, desmopressin was reinitiated orally, at a dose of0.1mg three times daily. Her therapy was finally balanced at adosage of 0.3mg twice daily (day 10; serum sodium level140 mmol/L). At follow-ups, 2 and 7 months later, she hadnormal serum sodium levels.

Patient 3, a 6-year-old boy, started receiving three sprays ofdesmopressin 10µg in each nostril per day (60 µg/day); he wasalso receiving oxybutynin. His parents reported severalepisodes of facial oedema and, 3.5 months after desmopressininitiation, his dosage was reduced to 40 µg/day; his oxybutynindosage was also reduced. One and a half months later, heexperienced abdominal pain and vomiting, and subsequentlylost consciousness and had clonic seizures. He washospitalised in a state of agitated coma with a Glasgow ComaScale score of < 7. Laboratory tests revealed a very lowsodium level of 115 mmol/L. He received a sodium chlorideinfusion and furosemide. He had increased diuresis (1.125L in< 6 hours) and regained consciousness. At 36 hours, he had asodium level of 137 mmol/L and, at 48 hours, a neurologicalexamination was normal and he was discharged. On day 5, hiselectrolyte levels were normal. He did not receive any furtherdesmopressin therapy.de la Gastine B, et al. Water intoxication with desmopressin in children: report ofthree cases. Therapie 62: 65-67, No. 1, Jan-Feb 2007 [French; summarised from atranslation] - France 801074731

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Reactions 2 Jun 2007 No. 11540114-9954/10/1154-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved