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The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
If ICP is dangerously high, (above 22mmHg) intravenous mannitol, an osmotic diuretic, may be given (Carney et al. 2016). Mannitol is a large-molecule sugar solution that rapidly increases the osmotic pressure of the blood. The increased osmotic pressure draws water from the interstitial space into the blood compartment, reducing interstitial cerebral oedema. Increases in blood volume are detected by the aortic and carotid baroreceptors and the atrial diastolic stretch receptors. Increased signals are sent to the vasomotor centre, indicating that the circulating volume is too high. Antidiuretic hormone is inhibited, and reabsorption of water by the kidneys ceases, causing an immediate diuresis. Mannitol is a potent osmotic diuretic, and patients may pass several litres of urine per hour. It is essential to maintain the patient’s electrolytes within normal range, particularly potassium, to prevent cardiac dysrhythmias as a complication of diuresis.
Congenital and acquired disorders of coagulation
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
Jeanne M Lusher, Roshni Kulkarni
Side-effects of desmopressin are generally minor (facial flushing and a feeling of facial warmth). However, the drug is a potent antidiuretic agent. Thus, there is a risk of hyponatraemia and water intoxication (which may be manifest by convulsions), especially if the patient is given large amounts of hypotonic fluids. (It is recommended that fluids be somewhat restricted for 18 hours post desmopressin, and that one monitor fluids and electrolytes in postoperative patients.) In view of a greater propensity to fluid balance problems in the very young and the elderly, desmopressin should be used with caution (or not at all) in children under 2 years of age, and in persons over 70. Additionally, in view of sporadic reports of coronary or cerebrovascular thrombosis associated with the use of desmopressin, it seems appropriate to avoid using it in those known to have risk factors for such complications.14
Pituitary and adrenal disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
Levels of antidiuretic hormone (ADH) (arginine vasopressin) are unchanged by pregnancy, but plasma osmolality falls early in gestation due to a reduction in serum sodium. The mean osmolality falls from about 290 to 280 mOsmol/L.
Physiological characterization of an arginine vasopressin rat model of preeclampsia
Published in Systems Biology in Reproductive Medicine, 2022
Sapna Ramdin, Thajasvarie Naicker, Virushka Pillay, Sanil D. Singh, Sooraj Baijnath, Blessing N Mkhwanazi, Nalini Govender
Glomerular damage increases glomerular permeability, thereby permitting entry of larger-sized proteins into the filtrate. The increase in peripheral vascular resistance due to AVP treatment, elevates systemic BP with consequent glomerular injury (Santillan et al. 2014) as demonstrated by the higher urinary protein levels observed in the AVP-treated rats in our study. Kidney histology as shown in Figure 4 highlights the effects of mild increase in mesangium, mild glomerular crescents and reduction in the Bowman’s space in AVP-treated rats (NAVP and PAVP). The Bowman’s capsular space protects glomerular function by acting as a shield against leukocyte infiltration (Chen et al. 2018). Glomerular epithelial crescents produced by the aggregation of inflammatory cells and proliferating epithelial cells in the Bowman’s space, are characteristic of glomerulonephritis (D’Souza et al. 2013). Thus, our data suggest an AVP-induced leukocyte infiltration and accompanying glomerular damage may contribute to increased urinary protein levels in the AVP- treated groups. In our study, water intake increased proportionally with gestational days amongst the pregnant (PAVP and PS) and NAVP groups, while urinary output reduced significantly in PAVP rats compared to the PS rats. Reductions in urinary output may be attributed to the antidiuretic effect of AVP, via V2 receptor activation and increased expression of aquaporin-2 channels resulting in water retention and reduced urinary output (Guelinckx et al. 2016).
Desmopressin acetate the first sublingual tablet to treat nocturia due to nocturnal polyuria
Published in Expert Review of Clinical Pharmacology, 2021
In a study examining gender differences in the antidiuretic response to desmopressin, males required 2.7-fold (95% CI: 1.3–8.1) higher exposure to desmopressin (ED50 value) than females to achieve an identical dynamic effect, indicating a higher desmopressin sensitivity among females. Resulting in an increased risk of developing hyponatremia in females (at 100 μg, decreases in serum sodium was approximately two-fold greater in women over 50 age than in men). The study also found the incidence hyponatremia increased with increasing dose and age [46]. This was further confirmed by a phase 2 study investigating low doses of ODST in water-loaded Japanese nocturia patients aged 55−74. The Duration of Antidiuretic Activity (DOA; defined as the time urine osmolality) was >200 mOsm/kg in participants. For female participants, following a single dose of ODST 25 ug, the DOA was longer (3 hours) compared to the DOA of male participants (1 hour). Signifying that males required 2.3-fold higher dose exposure to desmopressin (about 58 μg) compared to females (25 μg) to achieve an equivalent DOA [47].
Pharmacologic therapies for the management of non-neurogenic urinary incontinence in children
Published in Expert Opinion on Pharmacotherapy, 2019
Tiernan Middleton, Pamela Ellsworth
DDAVP may decrease the excretion rate and thus result in higher serum levels of abacavir, acarbose, acetaminophen, and acrivastine. DDAVP may increase the risk and severity of hypertension, hyponatremia and water intoxication if taken with aceclofenac, acemetacin, acetylsalicylic acid. Adefovir and acyclovir may lower the excretion rate of DDAVP which may result in higher serum levels. Concomitant administration with loperamide may result in a three-fold increase in the plasma concentration of desmopressin. Co-administration with other medications that increase the risk for syndrome of inappropriate antidiuretic hormone (SIADH) may cause an additive antidiuretic effect increasing risk for hyponatremia and water retention[10]. Such medications include SSRIs, tricyclic antidepressants, chlorpromazine, carbamazepine, and some sulfonylurea-based antidiabetic agents.