Abstract: SA-PO1030
The Role of Desmopressin in the Management of Severe Hypovolemic Hyponatremia
Session Information
- Water/Urea/Vasopressin, Organic Solutes
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Fluid, Electrolytes, and Acid-Base
- 702 Water/Urea/Vasopressin, Organic Solutes
Authors
- Ward, Frank, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
- Naimark, David M., Sunnybrook Health Science Centre, Toronto, Ontario, Canada
Background
The role of desmopressin (DDAVP) to prevent or treat rapid serum sodium concentration ([Na]s) correction during hyponatremia management remains unclear. The study aim was to assess DDAVP use during the first 48-hours of severe, hypovolemic hyponatremia management. The primary study hypothesis was that the use of DDAVP would slow the rate of [Na]s correction compared to those not receiving DDAVP.
Methods
A retrospective, observational study was conducted in a single, tertiary centre of all patients managed for severe, hypovolemic hyponatremia over a 12-month period. Inclusion criteria were [Na]s <125mmol/l at referral, serum osmolality <275mOsm/kg, urine sodium <30mmol/l and urine osmolality >100mOsm/kg. Patients with signs of extra-cellular fluid compartment overload were excluded. The primary outcome measure was [Na]S correction during the first 48-hours, compared between patients who did or did not receive DDAVP using linear regression.
Results
Twenty-eight patients were identified, with baseline mean [Na]s of 112.7±6.6mmol/l vs 117±4.3mmol/l (p=0.06) in those who received (n=16) and did not receive DDAVP (n=12), respectively. The DDAVP group had a more rapid [Na]s correction on the first day compared to those who did not receive DDAVP, 7.7±3.8mmol/l/day vs 5.1±2.0mmol/l/day (p=0.04). On the second day, there was a similar rate of [Na]s correction for those receiving DDAVP and those who did not, 1.3±4.3mmol/l/day vs 2.6±3.2mmol/l/day (p=0.39). Overall, there was no difference in [Na]s correction after 48-hours between those who received DDAVP and those who did not, 121.7±7.5mmol/l vs 124.8±5.7mmol/l (p=0.24). Patients who had experienced an over-correction were successfully treated with DDAVP (n=5), so that no patient had an ongoing over-correction by 48-hours. The final [Na]s for patients who received a single dose of DDAVP (n=7) was similar to those who received multiple doses (n=9), 123.8±5.8mmol/l vs 120±8.5mmol/l, p=0.32.
Conclusion
DDAVP appears safe and effective in the management of severe, hypovolemic hyponatremia, associated with similar [Na]s correction to those who did not receive DDAVP after 48-hours, despite an initial more rapid correction. A single dose of DDAVP may be as effective as multiple doses. A randomized trial should examine what benefit DDAVP confers in addition to standard care in the management of severe, hypovolemic hyponatremia.