Most of the clinical data on the safety profile of
desmopressin (
DDAVP), which is an effective treatment for both polyuric conditions and
bleeding disorders, originate from studies on the tailoring of
drug treatment, whereas few reports exist describing severe side effects secondary to
drug-drug interaction. We herein describe a case of severe
hyponatremia complicated by seizure and
coma due to the intake of non-steroidal anti-inflammatory drugs (
NSAIDs) in a patient on
DDAVP replacement
therapy for
central diabetes insipidus (DI). A 50-yr-old Caucasian man, with congenital central DI, developed an episode of
generalized tonic-clonic seizure, resulting in
coma immediately after being admitted to the Emergency Unit for weakness and
emesis. Based on his medical history and clinical findings,
water intoxication secondary to
ketoprofen intake (200 mg/day for the last 3 days) concomitant with
DDAVP replacement
therapy (
Minirin(®) 60 mcg 4
tablets a day) was hypothesized as being the cause of the severe euvolemic hypotonic
hyponatremia (natremia 113 mEq/l, plasma osmolality 238 mOsm/Kg). After standard emergency procedures, appropriate gradual restoration of serum
sodium levels to the normal range was achieved in 72 hours. Hydratation was maintained according to water excretion and
desmopressin therapy was re-introduced. We discuss this case report in the context of the published literature. The present report first highlights the potentially life-threatening side effects associated with over-the-counter
NSAIDs during
DDAVP replacement
therapy for central DI. Risks and benefits of co-treatment should be carefully considered and therapeutic alternatives to
NSAIDs should be recommended to patients with central DI in order to improve
DDAVP safety.