Abstract: FR-PO0875
Novel Dual Therapy Treatment of Severe Postobstructive Diuresis with Desmopressin and Sodium Supplementation
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 1
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Pendekanti, Shrita L., Harbor-UCLA Medical Center Department of Internal Medicine, Torrance, California, United States
- Shah, Anuja P., Harbor-UCLA Medical Center Division of Nephrology, Hypertension and Transplantation, Torrance, California, United States
- Dai, Tiane, Harbor-UCLA Medical Center Division of Nephrology, Hypertension and Transplantation, Torrance, California, United States
Introduction
Post-obstructive diuresis (POD) is characterized by excessive urine output following relief of urinary obstruction and may result in severe electrolyte abnormalities and hemodynamic instability. Most cases resolve with supportive care and volume replacement; however, refractory POD lacks standardized treatment approaches. Use of desmopressin (DDAVP) may be limited by concurrent hyponatremia, requiring careful dose titration and close electrolyte monitoring. We describe successful treatment of severe mixed water-solute POD using combined DDAVP and sodium supplementation.
Case Description
A 62-year-old male with hypertension and benign prostatic hyperplasia presented with one week of dysuria and near-anuric urinary output. Foley catheter placement resulted in immediate drainage of 3 liters of urine. Initial laboratory evaluation showed serum sodium 128 mEq/L and creatinine 6.69 mg/dL without known chronic kidney disease. Computed tomography demonstrated marked prostatomegaly with diffuse bladder wall thickening and moderate-to-severe hydronephrosis.
Despite aggressive intravenous fluid replacement, the patient developed persistent polyuria ranging from 4–11 liters/day for more than two weeks with sustained negative fluid balance. Repeat urine studies demonstrated elevated osmolar excretion (1656 mOsm/24 hours) and marked natriuresis (urine sodium 567 mEq/L), consistent with mixed water-solute diuresis secondary to impaired urinary concentrating ability and medullary washout. Persistent hyponatremia complicated management because DDAVP therapy risked worsening free water retention and further sodium decline.
Treatment was initiated with carefully titrated DDAVP (0.05 mg twice daily increased to 0.2 mg twice daily) combined with oral sodium supplementation (1–2 g three times daily). Temporary recurrence of severe diuresis after DDAVP interruption improved following re-initiation. Serum sodium improved from 123–128 mEq/L to >134 mEq/L, while polyuria resolved within five days of treatment initiation.
Discussion
This case highlights successful treatment of severe refractory POD using combined DDAVP and sodium supplementation. Hyponatremia significantly complicated DDAVP therapy and required careful dose titration with sodium supplementation. Early recognition and targeted dual therapy may shorten duration of severe diuresis and reduce hospital length of stay in refractory POD.
Acknowledgment
We acknowledge the use of ChatGPT by OpenAI (https://chatgpt.com) for assistance with generating a literature review and outline structure for this abstract.