WATER-INTOXICATION IN A PATIENT WITH THE PRADER-WILLI-SYNDROME TREATED WITH DESMOPRESSIN FOR NOCTURNAL ENURESIS

Purpose: We report on a girl with the Prader-Willi syndrome who receiv ed desmopressin for nocturnal enuresis, and water intoxication develop ed after she ingested a large amount of fluid. Materials and Methods: The patient received 10 mg. desmopressin at bedtime for enuresis. She was hospitalized when a major motor seizure and coma (Glasgow coma sca le 8) occurred after ingesting 48 ounces of fluid. Treatment included 3% saline, followed by 5% dextrose in water and sodium chloride given intravenously. Results: Serum sodium increased to 128 mEq./l. and seru m glucose remained normal. Computerized tomography and magnetic resona nce imaging of the head were normal and revealed no evidence of cerebr al pontine myelinosis. Patient consciousness returned to normal by day 5 after the seizure. Conclusions: In patients treated with desmopress in the risk of a seizure or altered level of consciousness can be mini mized by not ingesting large quantities of fluid. We recommend that pa tients drink no more than 8 ounces of fluid on any evening that desmop ressin is administered.