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Original ArticlesAcid/Base and Electrolyte Disorders
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Use of Desmopressin Acetate in Severe Hyponatremia in the Intensive Care Unit

Cédric Rafat, Frédérique Schortgen, Stéphane Gaudry, Fabrice Bertrand, Romain Miguel-Montanes, Vincent Labbé, Jean-Damien Ricard, David Hajage and Didier Dreyfuss
CJASN February 2014, 9 (2) 229-237; DOI: https://doi.org/10.2215/CJN.00950113
Cédric Rafat
*Medical-Surgical Intensive Care Unit, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France;
†Diderot University of Paris, Sorbonne Paris Cité, Paris, France;
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Frédérique Schortgen
‡Medical Intensive Care Unit, Henri Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France;
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Stéphane Gaudry
*Medical-Surgical Intensive Care Unit, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France;
§Institut National de la Santé et de la Recherche Médicale U722, Paris, France; and
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Fabrice Bertrand
*Medical-Surgical Intensive Care Unit, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France;
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Romain Miguel-Montanes
*Medical-Surgical Intensive Care Unit, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France;
†Diderot University of Paris, Sorbonne Paris Cité, Paris, France;
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Vincent Labbé
*Medical-Surgical Intensive Care Unit, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France;
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Jean-Damien Ricard
*Medical-Surgical Intensive Care Unit, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France;
†Diderot University of Paris, Sorbonne Paris Cité, Paris, France;
§Institut National de la Santé et de la Recherche Médicale U722, Paris, France; and
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David Hajage
‖Department of Public Health, Epidemiology, and Clinical Research, Bichat hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Didier Dreyfuss
*Medical-Surgical Intensive Care Unit, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France;
†Diderot University of Paris, Sorbonne Paris Cité, Paris, France;
§Institut National de la Santé et de la Recherche Médicale U722, Paris, France; and
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Summary

Background and objectives Excessive correction of chronic and profound hyponatremia may result in central pontine myelinolysis and cause permanent brain damage. In the case of foreseeable or established hyponatremia overcorrection, slowing down the correction rate of sodium plasma levels (PNa) or reinducing mild hyponatremia may prevent this neurologic complication.

Design, setting, participants, & measurements This retrospective and observational study was performed with 20 consecutive patients admitted to two intensive care units for severe hyponatremia, defined by PNa <120 mmol/L and/or neurologic complications ascribable to hyponatremia and subsequently treated by desmopressin acetate (DDAVP) during correction of hyponatremia when the rate of correction was overtly or predictably excessive. The primary endpoint was the effectiveness of DDAVP on PNa control.

Results DDAVP dramatically decreased the rate of PNa correction (median 0.81 mmol/L per hour [interquartile range, 0.46, 1.48] versus −0.02 mmol/L per hour [−0.16, 0.22] before and after DDAVP, respectively; P<0.001) along with a concurrent decrease in urine output (650 ml/h [214, 1200] versus 93.5 ml/h [43, 143]; P=0.003), and a rise in urine osmolarity (86 mmol/L [66, 180] versus 209 mmol/L [149, 318]; P=0.002). The maximal magnitude of PNa variations was also markedly reduced after DDAVP administration (11.5 mmol/L [8.25, 14.5] versus 5 mmol/L [4, 6.75]; P<0.001). No patient developed seizures after DDAVP or after subsequent relowering of PNa that occurred in 11 patients.

Conclusions Desmopressin acetate is effective in curbing the rise of PNa in patients admitted in the intensive care unit for severe hyponatremia, when the initial rate of correction is excessive.

  • Received January 28, 2013.
  • Accepted October 1, 2013.
  • Copyright © 2014 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 9 (2)
Clinical Journal of the American Society of Nephrology
Vol. 9, Issue 2
February 07, 2014
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Use of Desmopressin Acetate in Severe Hyponatremia in the Intensive Care Unit
Cédric Rafat, Frédérique Schortgen, Stéphane Gaudry, Fabrice Bertrand, Romain Miguel-Montanes, Vincent Labbé, Jean-Damien Ricard, David Hajage, Didier Dreyfuss
CJASN Feb 2014, 9 (2) 229-237; DOI: 10.2215/CJN.00950113

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Use of Desmopressin Acetate in Severe Hyponatremia in the Intensive Care Unit
Cédric Rafat, Frédérique Schortgen, Stéphane Gaudry, Fabrice Bertrand, Romain Miguel-Montanes, Vincent Labbé, Jean-Damien Ricard, David Hajage, Didier Dreyfuss
CJASN Feb 2014, 9 (2) 229-237; DOI: 10.2215/CJN.00950113
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