Morbidity and mortality associated with vasopressin replacement therapy inchildren

Objective: To assess the incidence and associated risk factors of adverse r eactions of DDAVP treatment of children with diabetes insipidus, comparing different routes of administration. Design: We retrospectively studied 103 children (44 females, 59 males) with cranial diabetes insipidus (mean age 6.9 years at diagnosis) treated with intramuscular (59), intranasal (84) and/or oral (64) DDAVP, over a mean fol low-up period of 5.2 years. Results: Eight patients died. For at least two children death was related t o water intoxication. Major complications (symptomatic water overload with or without seizures) or asymptomatic hyponatraemia were observed in 33 pati ents. The incidence of total complications was significantly higher in cort isol deficient patients than in those with normal cortisol reserve (36% vs 6%). In patients on concomitant carbamazapine treatment major complications were more frequent in comparison to the remaining patients (33% vs 10%). A lthough not achieving significance, there were fewer complications using th e oral route. Conclusions: Caution is needed in managing patients with DI, especially if risk factors such as cortisol deficiency or concomitant carbamazepine treat ment are present. The oral route of administration seems to be preferred fo r both convenience and safety. Major changes in dose and formulation should be undertaken in hospital.