Kathryn Pidcock, PharmD, BCPS
Clinical Pharmacy Specialist
Houston Methodist Hospital
Houston, Texas, United States
Disclosure information not submitted.
Neil Sutaria, MD
Nephrologist
Houston Methodist Hospital, United States
Disclosure information not submitted.
Hayley Brazeale, PharmD
Clinical Pharmacy Specialist
Houston Methodist Hospital
Houston, Texas, United States
Disclosure information not submitted.
Title: Desmopressin vs. Dextrose in Water for Therapeutic Re-lowering of Sodium
Introduction: Hyponatremia is an electrolyte disorder which is often difficult to correct. Safe correction of sodium is essential to prevent devastating neurologic complications. In the event of anticipated or observed overcorrection of sodium, desmopressin (1-desamino-8-d-arginine vasopressin, or DDAVP) and/or dextrose 5% in water (D5W) may be used to slow the rate of sodium increase. The purpose of this study is to compare the efficacy and safety of these agents in the setting of hyponatremia management.
Methods: This retrospective, observational study included 369 patients who were treated for hyponatremia (defined by a serum sodium < 130 mEq/L) and subsequently received DDAVP and/or D5W. The primary endpoint of the study was the change in serum sodium within 24 hours of reversal agent initiation (ΔNa24).
Results: The use of both DDAVP and D5W was found to reduce ΔNa24 significantly more than either agent alone (1.5 vs 1 vs -1 mEq/L for DDAVP, D5W, and both, respectively; p < 0.001). This finding was primarily driven by the differences between groups in patients treated with DDAVP in a reactive strategy (those who were given a reversal agent after an observed sodium correction of > 0.5 mEq/L/hr). The use of both agents was also associated with an increased incidence of rebound overcorrection (1% vs 4% vs 16% for DDAVP, D5W, and both, respectively; p < 0.001). The incidence of osmotic demyelination syndrome was assessed via the frequency of head imaging; no differences were found between groups.
Conclusions: The use of both DDAVP and D5W is more effective at reducing the rate of correction of serum sodium in the setting of hyponatremia management than either treatment alone. The combination of these therapies may be associated with higher rates of rebound overcorrection following their discontinuation.