1. GP Anesthetist, Halton Healthcare Services, Georgetown Hospital, Georgetown, Ontario, Canada.
3. Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
We report a 21-year-old male who underwent surgical repair of facial fractures 5 days following trauma. The patient developed rapidly progressive hyponatremia (serum sodium nadir, 123 mmol/l) and acute cerebral edema that progressed to transtentorial herniation and death following prophylactic desmopressin (20 μg) given 30 minutes preoperatively for congenital platelet function defect. Other contributing factors included a preceding 3-day prodrome of hypernatremia secondary to neurogenic diabetes insipidus (which may have made the brain more susceptible to injurious effects of perioperative acute hyponatremia) and intra-/postoperative administration of large volumes of crystalloid. This fatal adverse effect of desmopressin underscores the need for careful patient selection when using this prohemostatic agent with a major antidiuretic (water-retaining) profile.
Keywords: Desmopressin, Brain injury, Trauma