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Abstract: SA-OR43

Safety and Efficacy of Proactive vs. Reactive Administration of DDAVP in Severe Symptomatic Hyponatremia: A Randomized Controlled Trial

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Kanjanasuphak, Nichanone, Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Sai Mai, ฺฺBangkok, Thailand
  • Chuasuwan, Anan, Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Sai Mai, ฺฺBangkok, Thailand
  • Gojaseni, Pongsathorn, Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Sai Mai, ฺฺBangkok, Thailand
  • Chittinandana, Anutra, Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Sai Mai, ฺฺBangkok, Thailand
  • Pakchotanon, Kamolwan, Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Sai Mai, ฺฺBangkok, Thailand
Background

DDAVP is effective in preventing and reversing overcorrection of hyponatremia. However, the recommended strategy for its use remains unclear and is based on retrospective data. This study aims to compare the safety and efficacy of proactive and reactive DDAVP strategies in severe symptomatic hyponatremia.

Methods

This randomized controlled trial included patients with severe symptomatic hyponatremia (serum sodium < 125 mmol/L) from June 20, 2022, to February 20, 2023. Patients were assigned to either the proactive group, which received DDAVP immediately after diagnosis, or the reactive group, which received DDAVP only if the serum sodium level tended to overcorrect. The primary outcome was the incidence of overcorrection between the two groups.

Results

The study enrolled 49 patients, with 24 in the proactive group and 25 in the reactive group. There was no significant difference in the incidence of overcorrection between the two groups (16.7% vs. 28%, P = 0.54), nor in the change of serum sodium levels at 1, 6, 12, and 24 hours. However, at 48 hours, the proactive group had a higher change in serum sodium levels than the reactive group (10.3 + 3.6 vs. 7.7 + 3.6, P = 0.013), but it remained within the safety range. The time to symptom improvement, total amount of intravenous fluid administered, dose of DDAVP, urine volume, length of hospital stay, incidence of ODS, and 28-day mortality did not differ significantly between the two groups.

Conclusion

This study found no significant difference in the incidence of overcorrection between the proactive and reactive strategies for treating severe symptomatic hyponatremia. However, future large studies are needed.