ICEECE2012 Poster Presentations Clinical case reports - Pituitary/Adrenal (58 abstracts)
Desmopressin and non steroidal anti-inflammatory drugs: a case report of severe water intoxication during replacement therapy and review of the literature
E. Verrua 1 , G. Mantovani 1 , A. Noto 2 , E. Ferrante 1 , E. Sala 1 , E. Malchiodi 1 , G. Iapichino 2, , P. Beck-Peccoz 1 & A. Spada 1
1University of Milan, Endocrinology and Diabetology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 2Ospedale San Paolo, Milan, Italy; 3University of Milan, Milan, Italy.
Context: Most of the clinical data on safety profile of desmopressin (DDAVP), i.e. an effective treatment of both polyuric conditions and bleeding disorders, originates from studies on tailoring of drug treatment, whereas few reports describe severe side effects secondary to drug–drug interaction.
Objective: To describe a case of severe hyponatremia complicated with seizure and coma due to the intake of non steroidal anti-inflammatory drugs (NSAIDs) in a patient on DDAVP replacement therapy for central diabetes insipidus (DI).
Patient and methods: We report a 50-year-old Caucasian man, with congenital central DI, who developed an episode of generalized tonic-clonic seizure, resulting in coma immediately after being admitted to the Emergency Unit for weakness and emesis. Based on his medical history and clinical findings, water intoxication secondary to ketoprofen intake (200 mg/day for the last 3 days) concomitant with DDAVP replacement therapy (Minirin 60 μg four tablets a day) was hypothesized as cause of the severe euvolemic hypotonic hyponatremia (natremia 113 mEq/l, plasma osmolality 238 mOsm/kg). After emergency procedures, the aquaretic tolvaptan (Samsca 7.5 mg) was administered and hydratation was maintained according to water excretion. He completely recovered in 72 h. We discuss this case report in the context of the published literature.
Conclusions: Contrary to the several cases of hyponatremia reported in patients on DDAVP for different indications, no study has highlighted the potentially life-threatening side effects associated with over-the-counter NSAIDs during DDAVP replacement therapy for central diabetes insipidus so far. Risks and benefits of co-treatment should be carefully considered and therapeutic alternatives to NSAIDs should be recommended to patients with central DI, in order to improve DDAVP safety.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.
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Endocrine Abstracts
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