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Abstract: FR-PO563

The Use of DDAVP During Overcorrection of Severe Hyponatremia

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

  • Lamarche, Florence, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Ammann, Helene, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Dallaire, Gabriel, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Deslauriers, Louis, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Troyanov, Stephan, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
Background

The correction of severe hyponatremia can be challenging. A too slow or rapid pace increases the risk of neurological complications. Current guidelines recommend a serum sodium (sNa) correction rate of ~6 mmol/L per day. Overcorrection can justify lowering the sNa. Desmopressin (DDAVP) is used to decrease free water excretion and thus stabilize or decrease the sNa but to date, the evidence supporting its use is scarce. We studied sNa trends after subcutaneous (SC) DDAVP administration in cases of severe hyponatremia.

Methods

We performed a single-center retrospective cohort study looking at all episodes of hypoosmolar hyponatremia. Every sNa value < 120 mmol/L from 2012 to 2022 was identified and all subsequent serum and urinary sodium and osmolarities were extracted. Spurious cases were excluded. Correction rates between all measurements separated by ≥ 8 hours were calculated and categorized from most to least clinically significant (Table). We also reviewed SC DDAVP administration and sNa trends following it.

Results

There were 388 episodes of severe hyponatremia in 356 patients. The correction rates and DDAVP received are listed in the table: 45% of patients had an overcorrection >9 over > 24h. Ninety episodes received DDAVP, 70 of which were followed by a drop in sNa. The average drop in sNa 12 h after receiving doses of 1 mcg (35 doses) and 2 mcg (31 doses) were -0.6 ± 3.5 mmol/L and -2.2 ± 3.1 mmol/L, respectively (p=0.035). Thirteen episodes treated with DDAVP experienced a >6 mmol/L maximal drop in sNa.

Conclusion

This cohort highlights frequent sNa overcorrections and the usefulness of SC DDAVP to slow or decrease sNa correction rates. One mcg SC DDAVP stabilized sNa for 12 hours whereas 2 mcg SC resulted in a mean 2 mmol/L decrease. The amount of water ingested must be carefully assessed when using DDAVP, as some experience worrisome drops in sNa.

Category (mmol/L)Cohort (%)DDAVP doses given (%)
>9/day over >48h18 (5%)5 (28%)
>9/day over 24-48h155 (40%)68 (44%)
7-9/day over >48h44 (11%)7 (16%)
7-9/day over 24-48h95 (24%)8 (8%)
>9/day over <24h24 (6%)2 (8%)
7-9/day over <24h33 (9%)0
Always ≤6/day19 (5%)0

Funding

  • Private Foundation Support