Evaluation of Desmopressin in Critically Ill Patients with Hyponatremia Requiring 3% Hypertonic Saline

Diagnosis and Management of Hyponatremia

“…Both groups achieved similar rates of target change in the serum sodium level at 24 hours (65.6% in the group receiving hypertonic saline with desmopressin vs 52.5% in the group receiving hypertonic saline without desmopressin; P = .21). Desmopressin did not decrease the incidence of overly rapid correction but increased duration of 3% sodium chloride (39.3 hours in the group receiving hypertonic saline with desmopressin vs 12.6 hours in the group receiving hypertonic saline without desmopressin; P = .002) and the amount of fluid received per patient (899 mL vs 514 mL, respectively; P = .003) . Another retrospective study of 64 patients with a serum sodium level of less than 115 mEq/L treated with hypertonic saline reported that safe correction of the serum sodium level (≤8 mEq/L) within 24 hours was higher in those receiving desmopressin (n = 47) than in those who did not receive desmopressin (n = 17) (68% vs 41%, respectively; P = .04) .…”

“…Desmopressin did not decrease the incidence of overly rapid correction but increased duration of 3% sodium chloride (39.3 hours in the group receiving hypertonic saline with desmopressin vs 12.6 hours in the group receiving hypertonic saline without desmopressin; P = .002) and the amount of fluid received per patient (899 mL vs 514 mL, respectively; P = .003). 55 Another retrospective study of 64 patients with a serum sodium level of less than 115 mEq/L treated with hypertonic saline reported that safe correction of the serum sodium level (Յ8 mEq/L) within 24 hours was higher in those receiving desmopressin (n = 47) than in those who did not receive desmopressin (n = 17) (68% vs 41%, respectively; P = .04). 56 In a retrospective study of 1450 patients, desmopressin slowed the rate of correction for the serum sodium level and prolonged hospital stay (6 days vs 5 days without desmopressin; P < .001), but was associated with higher rates of overly rapid correction (29.1% vs 15.5%, respectively; P < .001).…”

The management of acute and chronic hyponatraemia

“…This acts to clamp urinary losses of electrolyte free water, and 3% saline is then titrated according to plasma sodium response. 51 While a recent retrospective study failed to show any reduction in overcorrection with this ‘pro-active’ approach, 52 it may be of use in those at a particularly high risk of rapid water diuresis with overcorrection of plasma sodium, e.g. hypovolaemic hyponatraemia, thiazide induced hyponatraemia, glucocorticoid deficiency and primary polydipsia, where treatment of the underlying condition results in restoration of the kidneys ability to excrete electrolyte-free water.…”