Journal of Anesthesiology & Clinical Science

Journal of Anesthesiology & Clinical Science

ISSN 2049-9752
Case report

Fatal Hyponatremia Associated with Preoperative Desmopressin for Bleeding Disorder

Joseph S Milkovic1+, Theodore E Warkentin2+*, Robert MA Richardson3+ and Ally PH Prebtani2+

*Corresponding author: Theodore E Warkentin twarken@mcmaster.ca

2. Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.


Author Affiliations

1. GP Anesthetist, Halton Healthcare Services, Georgetown Hospital, Georgetown, Ontario, Canada.

3. Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Abstract

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

ISSN 2049-9752
Volume 1
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