Coma and seizures due to severe hyponatremia and water intoxication in an adult with intranasal desmopressin therapy for nocturnal enuresis

Desmopressin, a synthetic analogue of the antidiuretic hormone, is an effec tive medication for primary nocturnal en uresis for both children and adult s. Its safety is well established. Although it has a favorable side effect profile, because of its pharmacological effect, intranasal desmopressin can rarely induce water intoxication with profound hyponatremia if given witho ut adequate restriction of wafer intake. The authors describe an adult pati ent with water intoxication and severe hyponatremia accompanied by loss of consciousness and seizures after 2-day intranasol administration of desmopr essin. The present and the previously reported cases emphasize the need for greater awareness of the development of this serious and potentially fatal complication. In addition, to adjust the drug to the lowest required dosag e, adequate restriction of water intake is recommended, and serum levels of sodium should be measured periodically to allow for early detection of wat er intoxication and hyponatremia. (C) 2001 the American College of Clinical Pharmacology.