Desmopressin for nocturnal enuresis
Desmopressin acetate is a synthetic derivative of the naturally occurring hormone vasopressin, which prevents the excretion of urine and is known as the antidiuretic hormone. Desmopressin acetate was recently approved for treating primary nocturnal enuresis, which is the persistent inability to retain urine during the night. This agent is used in the nasal spray dosage form, and is similar to a desmopressin solution applied in the nose for treating central diabetes insipidus, the excessive ingestion and excretion of water resulting from impaired secretion of vasopressin from the pituitary gland. Children with nocturnal enuresis do not require treatment up to the age of six, and 15 percent of cases resolve spontaneously each year thereafter. Nocturnal enuresis affects less than one percent of adults. Only ten percent of the dose applied by nasal spray is absorbed, and reaches peak levels in the blood within 45 minutes after administration. Fifty percent of the drug is eliminated from the body within four to six hours and drug action may last from six to 24 hours. Studies suggest that the secretion of vasopressin at night may be suppressed among children with nocturnal enuresis. Clinical trials and human studies which have examined the effectiveness of desmopressin have shown that this agent, applied in a nasal spray at bedtime, decreases bedwetting in some children with nocturnal enuresis. Adverse or unfavorable side effects of desmopressin include nose bleed, pain and congestion of the nose, headache, inflammation of the membranes lining the nose and eye, chills, dizziness, nausea, and abdominal pain. In addition, there have been rare reports of water intoxication, hyponatremia or decreased blood sodium, convulsion, and coma after treatment with desmopressin. The high rate of spontaneous resolution and potential toxic effects should be considered when deciding whether to prescribe desmopressin for treatment of nocturnal enuresis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Medical Letter on Drugs and Therapeutics
Long-term control of blood pressure and sodium balance: is the baseline nocturnal?
Nocturnal pressure during undisturbed sleep was hypothesized to be the baseline signal for long term regulation of sodium excretion. An additional element of the hypothesis is that the glomerulus is the site providing the signal for linking nocturnal pressure to the next day's sodium excretion. However, this hypothesis can neither be refuted nor confirmed due to lack of specific experimental designs to test it.
Publication Name: Perspectives in Biology and Medicine
A 25-Year-Old Man with Uncontrollable Thirst and Polyuria
The article describes the diagnosis of nephrogenic diabetes insipidus in a 25-year-old white male. Topics include the man's health condition upon arrival at the hospital, and therapeutic use of desmospressin acetate.
Publication Name: Physician Assistant
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