DESMOPRESSIN

ADMINISTRATION  ROUTES: IV,  IM,  SC,  Intranasal DDAVP/Desmopressin

INDICATIONS: 

1. Treatment  of  central  diabetes  insipidus 2. Prevention  and  control  of  bleeding  (primarily  when  there  are  fancy  to  be platelet  duty  defects  especially  uraemia,  clopidogrel  or  cardiopulmonary bypass  -of the same family)

 PRESENTATION AND ADMINISTRATION: 

IV: Minirin  4mcg/ml  lavement Octostim  15mcg/ml  enema Doses  of  4mcg  or  not so much  should  be  administered  undiluted  through  direct  IV  enema.    For small  doses  (eg  0.4mcg),  4mcg  be able to  be  diluted  in  10  ml  of  according to rule  saline. For  doses  of  greater  than  4mcg  in  adults  or  children  weighing  more  than  10kg,  dilute with  50ml  of  ordinary  saline  and  ingraft  the  first  5ml  slowly  throughout  5  minutes.    For  children weighing  not so much  than  10kg,  make more liquid  in  10ml  of  legitimate  saline  and  infuse  the  first  1-2ml  upward of  5 minutes.    If  ~t any  marked  tachycardia  or  other  opposing  effects  are  observed,  bestow  the remainder  slowly  outer  15  minutes PO: Minirin  0.1mg  tablets  (pale)

 Nasal  Spray: Desmopressin  bough  (10mcg/dose),  Minirin  twig  (10mcg/dose),  Octostim  (150mcg/ prescribed portion ) 

DOSAGE: 

IV: Central  diabetes  insipidus: 0.4mcg  repeated  as  required  (may  greaten  the  dose  whether  there  is  each  adequate  response)

 Prevention  and  sway  of  bleeding: 0.3mcg/kg  (max  24mcg)  in excess  30  minutes  (once  only) Note:  although  IM  and  SC  routes  be possible to  be  used,  IV  is  commonly  the  preferred  course. PO: 0.1mg  -1.2mg  quotidian  depending  on  indication  (rarely  used  ~ the agency of  this  route  in  ICU)

 Nasal  Spray: Not  without details  administered  by  this  route  in  ICU

No adjustments needed in CRF

CLINICAL  PHARMACOLOGY: Desmopressin  is  a  synthetic  counterpart  of  the  artless  pituitary  hormone  arginine vasopressin  (ADH),  every  antidiuretic  hormone  touching  renal  water  maintenance..

 CONTRAINDICATIONS: 

1. Hypersensitivity  to  desmopressin 2. Hyponatraemia

 WARNINGS 

When  desmopressin  acetate  lavement  is  administered  to  patients  who  terminate  not  have  want of  antidiuretic  hormone  toward  its  antidiuretic  power,  in  particular  in  paediatric  and  geriatric patients,  fluid  intake  should  have ~ing  adjusted  downward  to  diminution  the  potential  incident of  water  intoxication  and  hyponatraemia.

 Particular  circumspection  should  be  paid  to  the  contingency  of  the  scarce  occurrence  of  ~y  extreme decrease  in  plasma  osmolality  that  may  resolve  in  seizures  that  could  lead  to  tuft. 

Laboratory  Tests:

 Laboratory  tests  notwithstanding  monitoring  the  unrepining  include  urine  bulk  and  osmolality.  In  more cases,  plasma  osmolality  may  exist  required.

NB: may  lead to  minor  increases  in  line  pressure  requiring  changes  in  levels  of vasopressor  basis. 

ADVERSE  REACTIONS 

 fleeting  headache,  ischaemic  hit,  changes  in  blood  pressure  causing  each  a  slight  promotion  or  a  imperfect  fall  and  a compensatory  augment  in  heart  be~,  myocardial  infarction, nausea, abdominal cramps, water  intoxication  and  hyponatraemia,Local  stimulation  at  site  of  lavement,  thrombotic  events

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