Complications
The normal thirst response is protective against the development of hypernatremia in patients with AVP-D or AVP-R. Hypernatremia can occur if patients have impaired free access to water.
Mild to moderate hypernatremia may present with irritability, restlessness, lethargy, muscle twitching, spasticity, or hyperreflexia.
The presence of delirium, seizures, or coma suggests severe hypernatremia.
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 unrecognized, this may lead to renal impairment. Monitoring with regular serum creatinine assessment and periodic renal and bladder ultrasound is recommended.[70]
Hyponatremia is common in patients with chronic AVP-D who are on replacement desmopressin (also known as DDAVP).[73] Most of this hyponatremia remains asymptomatic.
Treatment is through appropriate desmopressin dose adjustment. The prevalence of hyponatremia is less in patients who practice "desmopressin escape" once a week to allow an aquaresis.
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