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Hyponatremic Seizure in a Child Using Desmopressin for Nocturnal Enuresis
Arch Pediatr Adolesc Med. 1998;152:1037-1038.
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The recent article by Donoghue et al1 reports a case of a previously healthy, but enuretic, 10-year-old boy who developed severe hyponatremia (nadir, 117 mmol/L) with resulting convulsions following 3 weeks of nightly 40-µg doses of intranasal desmopressin therapy. What was the weight of their patient? The authors nicely commented on some of the pitfalls of such therapy and reviewed some of the published reports of similar circumstances. Complications likely are underreported.
But I would like to add 2 additional comments. Apparently, this child initially well tolerated the desmopressin but developed emesis and pharyngitis and was treated with an antibiotic the day before the convulsion occurred. I agree that it is unlikely that the few bouts of emesis played any significant role in the child's overall fluid balance, but nausea and vomiting are stimulators of endogenous vasopressin (antidiuretic hormone) release.2 In addition, it is my (and others') anecdotal experience in . . . [Full Text of this Article]
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