Rôle du médecin traitant dans les convulsions hyponatrémiques chez l'enfant énurétique traité par desmopressine

OBJECTIVE: Dilutional hyponatremia is a serious adverse effect of desmopressin, a vasopressin analog that is widely prescribed to manage monosymptomatic enuresis. The presentation of hyponatremia, largely related to cerebral dysfunction, can include severe signs like altered mental status and seizures. METHODS: We reviewed the literature dealing with altered mental status or seizures in enuretic subjects on desmopressin. The retained publications included patients who were described individually, revealing data on mode of administration, further identifiable factors predisposing to hyponatremia, presentation and clinical course. RESULTS: We found 54 cases of hyponatremia secondary to desmopressin treatment presenting with altered mental status or seizures. In most cases the complication developed 14 days or less after starting desmopressin. An intranasal formulation had been used in 47 patients. Excess fluid intake was documented as a contributing factor in at least 22 cases. In 6 cases severe signs of hyponatremia developed in the context of intercurrent illnesses. CONCLUSION: Altered mental status or seizures are very rare but recognized complications of desmopressin in enuresis. This complication mostly develops in subjects managed with the intranasal formulation 14 days or less after starting the medication, following excess fluid intake and during intercurrent illnesses.

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Severe signs of hyponatremia secondary to desmopressin treatment for enuresis: A systematic review

Lucchini

Simonetti

Ceschi

et al. 2013

Journal of Pediatric Urology

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The Comparative Safety of Oral Versus Intranasal Desmopressin for the Treatment of Children With Nocturnal Enuresis

2007

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Data suggest that there is a decreased risk of hyponatremia with oral desmopressin compared with intranasal desmopressin. Identifiable and preventable risk factors for hyponatremia are inappropriately high fluid intake, administration of a larger than recommended dose, young age (less than 6 years) and concomitant administration of another medication. When desmopressin is prescribed, patients should be instructed to avoid high fluid intake when the medication is ingested, not ingest a higher than recommended dose and promptly discontinue the medication and seek assessment if headache, nausea or vomiting develops.

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Two Unusual Pediatric Cases of Dilutional Hyponatremia

Boetzkes

Hoeck

Verbrugghe

et al. 2010

Pediatric Emergency Care

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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.

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Rôle du médecin traitant dans les convulsions hyponatrémiques chez l'enfant énurétique traité par desmopressine

Cited by 4 publications

References 7 publications

Severe signs of hyponatremia secondary to desmopressin treatment for enuresis: A systematic review

Severe signs of hyponatremia secondary to desmopressin treatment for enuresis: A systematic review

The Comparative Safety of Oral Versus Intranasal Desmopressin for the Treatment of Children With Nocturnal Enuresis

Two Unusual Pediatric Cases of Dilutional Hyponatremia

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