BMJ Case Reports 2011; doi:10.1136/bcr.07.2011.4512
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Preventing overcorrection of hyponatraemia with desmopressin

  1. Steve Riley3
  1. 1East Wandsworth Older Adults CMHT, Springfield Hospital, London, UK
  2. 2Department of Respiratory Medicine, Glan Clwyd Hospital, Rhyl, UK
  3. 3Institute of Nephrology, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Sophie Claire Tomlin, sophie_tomlin{at}


A 61-year-old woman was admitted with history of vomiting, diarrhoea and severe hyponatraemia (Na+ 109). The cause of the hyponatraemia was due to intravascular volume depletion resulting in a non-osmotic release of antidiuretic hormone (ADH) with the added effects of a thiazide diuretic. She was also on fluoxetine which may induce inappropriate secretion of ADH. Despite cautious fluid replacement, the patient’s serum sodium increased by 12 mmol/l over the first 18 h (and by 10 mmol/l over 12 h). This trajectory, coupled with the rapid decrease in urine osmolality, suggested that this patient was at risk of significant brain injury due to rapid correction of serum sodium. The use of desmopressin slowed the rise in serum sodium allowing brain adaptive mechanisms time to protect against osmotic demyelination.


  • Competing interests None.

  • Patient consent Obtained.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article