Complications
The normal thirst response is protective against the development of hypernatraemia in patients with AVP-D or AVP-R. Hypernatraemia can occur if patients have impaired free access to water.
Mild to moderate hypernatraemia may present with irritability, restlessness, lethargy, muscle twitching, spasticity, or hyper-reflexia.
The presence of delirium, seizures, or coma suggests severe hypernatraemia.
Treatment includes the correction of serum sodium via oral and/or intravenous fluids. Serial serum electrolyte and osmolality measurements should be obtained to assess response to therapy.
Patients with AVP-R may develop bladder dysfunction in response to excess urine production. If unrecognised, this may lead to renal impairment. Monitoring with regular serum creatinine assessment and periodic renal and bladder ultrasound is recommended.[66]
Hyponatraemia is common in patients with chronic AVP-D who are on replacement desmopressin (also known as DDAVP).[69] Most of this hyponatraemia remains asymptomatic.
Treatment is through appropriate desmopressin dose adjustment. The prevalence of hyponatraemia is less in patients who practice ‘desmopressin escape’ once a week to allow an aquaresis.
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