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Recurrent hyponatremia under desmopressin overdosing—is abuse a possible explication?

Nasal desmopressin, a widely used antidiuretic hormone (ADH) analog is a well-established pharmaceutical to treat patients suffering from central diabetes insipidus [1] . Hyponatremia is a well-known side effect of desmopressin treatment and is, in many cases, associated with inappropriate use by the patients [2] . We present a case in which a suspected abuse of desmopressin might be a possible explication for recurrent hyponatremia in a patient having central diabetes insipidus.</P>Because of a recurrent depressive disorder Mr R, a 63-year-old man, had been treated as an inpatient in the Department of Psychiatry and Psychotherapy 4 times since 1995. The patient had been suffering from central diabetes insipidus for more than 40 years, treated with nasal desmopressin 20 μ g daily (applied by the patient himself). At admission, no relevant psychopathological symptoms were found apart from a depressive episode (MADRS: 13 points). In addition, we found no evidence for dementia (Mini-Mental State Examination: 29 points). During hospitalization, the patient had severe hyponatremia (114 mmol/L; at admission, 134 mmol/L). We explained to the patient that the hyponatremia is associated with the nasal desmopressin application. However, sodium serum levels did not increase during treatment with restriction of water intake, restriction http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The American Journal of Emergency Medicine Elsevier
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