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Background <p>Platelet dysfunction in the setting of intracranial hemorrhage may potentiate worsening hemorrhage. Desmopressin may be used to treat platelet dysfunction in intracranial hemorrhage through von Willebrand factor release. Hypertonic saline is often used in this population to treat cerebral edema and elevated intracranial pressure. Free water reabsorption associated with desmopressin may attenuate the effect of hyperosmolar therapy. The effect of desmopressin on continuous infusion 3% sodium chloride (3%) when targeting a specific sodium goal has not been definitively elucidated. We hypothesize that a lower proportion of patients treated with desmopressin will have achieved a serum sodium of ≥ 150&#xa0;mEq/L at 48&#xa0;h versus those that did not receive desmopressin.</p> Methods <p>This is a retrospective cohort study at a level-1 trauma center and quaternary care center that included patients who received 3% infusions for at least 48&#xa0;h following admission in the setting of intracranial hemorrhage of varying etiologies. The primary end point is the proportion of patients reaching a serum sodium of ≥ 150&#xa0;mEq/L within 48&#xa0;h of 3% initiation. To account for confounding variables, a logistic regression adjusted analysis was also performed to evaluate the primary end point.</p> Results <p>A total of 127 patients were included in this study; 75 were not treated with desmopressin, and 52 were treated with desmopressin. There was no significant difference noted in the attainment of serum sodium of 150&#xa0;mEq/L within 48&#xa0;h of 3% therapy in the control versus desmopressin group (47 [62.7%] vs. 34 [65.4%]; <i>P</i> = 0.7540). Adjusted logistic regression evaluating the effect of DDAVP on sodium goal attainment did not reach statistical significance (odds ratio 1.59 [95% confidence interval 0.56–4.52], <i>P</i> = 0.3851).</p> Conclusions <p>Desmopressin does not appear to affect the ability to attain a therapeutic hypernatremia goal of ≥ 150&#xa0;mEq/L within 48&#xa0;h when using continuous infusion hypertonic saline.</p>

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Effect of Desmopressin on Attaining Therapeutic Hypernatremia with Hypertonic Saline Continuous Infusion in Intracranial Hemorrhage

  • 期刊论文

  • 发表日期：

    2026年1月21日

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  • Skylar Villegas,
  • Daniel Jenniches,
  • Sarah Young,
  • Yue Yin,
  • Matthew R. Noorbakhsh

摘要

Background

Platelet dysfunction in the setting of intracranial hemorrhage may potentiate worsening hemorrhage. Desmopressin may be used to treat platelet dysfunction in intracranial hemorrhage through von Willebrand factor release. Hypertonic saline is often used in this population to treat cerebral edema and elevated intracranial pressure. Free water reabsorption associated with desmopressin may attenuate the effect of hyperosmolar therapy. The effect of desmopressin on continuous infusion 3% sodium chloride (3%) when targeting a specific sodium goal has not been definitively elucidated. We hypothesize that a lower proportion of patients treated with desmopressin will have achieved a serum sodium of ≥ 150 mEq/L at 48 h versus those that did not receive desmopressin.

Methods

This is a retrospective cohort study at a level-1 trauma center and quaternary care center that included patients who received 3% infusions for at least 48 h following admission in the setting of intracranial hemorrhage of varying etiologies. The primary end point is the proportion of patients reaching a serum sodium of ≥ 150 mEq/L within 48 h of 3% initiation. To account for confounding variables, a logistic regression adjusted analysis was also performed to evaluate the primary end point.

Results

A total of 127 patients were included in this study; 75 were not treated with desmopressin, and 52 were treated with desmopressin. There was no significant difference noted in the attainment of serum sodium of 150 mEq/L within 48 h of 3% therapy in the control versus desmopressin group (47 [62.7%] vs. 34 [65.4%]; P = 0.7540). Adjusted logistic regression evaluating the effect of DDAVP on sodium goal attainment did not reach statistical significance (odds ratio 1.59 [95% confidence interval 0.56–4.52], P = 0.3851).

Conclusions

Desmopressin does not appear to affect the ability to attain a therapeutic hypernatremia goal of ≥ 150 mEq/L within 48 h when using continuous infusion hypertonic saline.