Seizures desmopressin

A 3.5-year-old girl with mild hemophilia A received desmopressin 0.3 micrograms/kg intravenously 30 minutes before adenotonsillectomy. She drank 600 ml of fluid within the first 10 hours and then received 300 ml of intravenous 5% dextrose in 0.45% saline. She developed hyponatremia, headache, nausea, and seizures. 

A potential risk of desmopressin is of water intoxication with resultant hyponatremia (48), and rapid falls in serum sodium concentration can result in seizures. The risk is increased in infants and patients receiving hypotonic intravenous fluids, and such patients need to be carefully monitored. 

A 37-year-old woman with primary enuresis continued her customary daily fluid intake (2 liters) when she started intranasal desmopressin 30 micrograms at night. Within 2 days she became severely hyponatre-mic, with loss of consciousness, generalized seizures, and cerebral edema. 

An 80-year-old woman with a high baseline fluid intake developed severe hyponatremia, with loss of consciousness and seizures, after a single dose of desmopressin 0.2 mg (49). 

A 47-year-old woman with von Willebrand disease, who was given desmopressin and intravenous fluids perioperatively, developed hyponatremia and seizures, which resolved after water restriction (50). 

There have been several reports of seizures in association with hyponatremia after intravenous administration of desmopressin to cover surgery in young children with congenital bleeding disorders such as mild hemophilia A or von Willebrand s disease (58-60). Hyponatremia and convulsions have occurred in children without congenital bleeding disorders who received desmopressin for urine concentration tests or to treat nocturnal enuresis (54,61,62). 

Molnar Z, Farkas V, Nemes L, Reusz GS, Szabo AJ. Hyponatraemic seizures resulting from inadequate postoperative intake following a single dose of desmopressin. Nephrol Dial Transplant 2005 20 2265-7. 

Passi GR, Shad R. Seizures and coma after desmopressin for nocturnal enuresis. Indian Pediatr 2004 41 1276-7. 

Odeh M, Oliven A. Coma and seizures due to severe hyponatremia and water intoxication in an adult with intranasal desmopressin therapy for nocturnal enuresis. J Clin Pharmacol 2001 41(5) 582-4. 

Pruthi RS, Kang J, Vick R. Desmopressin induced hyponatremia and seizures after laparoscopic radical nephrectomy. J Urol 2002 168(1) 187. 

Shepherd LL, Hutchinson RJ, Worden EK, Koopmann CF, Coran A. Hyponatremia and seizures after intravenous administration of desmopressin acetate for surgical hemostasis. J Pediatr 1989 114(3) 470-2. 

One report described adverse reactions in two pregnant women with von Willebrand disease (59). One went into premature labor after a single dose (attributed to the oxytocic effect of desmopressin) and the other had severe hyponatremia associated with seizures after repeated administration of desmopressin to cover a cesarean section. 

Infrequent adverse effects of desmopressin spray include nasal irritation, epistaxis, rhinitis, and nasal congestion, whereas desmopressin tablets or spray may cause transient headache, chills, dizziness, nausea, and abdominal pain. Rarely, water intoxication, hyponatremia, and subsequent tonic-clonic seizures have been reported, " particularly in children with concurrent physical disorders, intentional overdoses, or excessive fluid intake. When desmopressin is administered, evening fluids should be limited to 8 ounces to prevent hyponatremia or water intoxication. ... 

Donoghue MB, Latimer E, Pillsbury HL, Hertzog JH. Hyponatremic seizure in a child using desmopressin for nocturnal enuresis. Arch Pe-diatr Adolesc Med 1998 152 290-292. 

Nervous system The safety of desmopressin in children with primary monosjmiptomatic nocturnal enuresis has been reviewed [86 ]. After 61 cases of seizures, including two deaths, the FDA asked that the prescribing information be changed in 2007 to state that desmopressin spray is no longer indicated for monosymptomatic nocturnal enuresis or in patients at risk of hyponatremia. The authors of the review concluded that hyponatremia often resulted from inappropriately high doses of desmopressin and usually occurs in the elderly people they supported continuing the use of desmopressin to treat monosymptomatic nocturnal enuresis imder appropriate medical supervision. Hyponatremia has been reported more commonly with the spray than with the oral formulation this may reflect differences in pharmacokinetics or more extensive evaluation of the spray. 

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