serum sodium alterations in children with primary monosymptomatic nocturnal enuresis using desmopressin

Background: hyponatremia/water intoxication has been considered a rare but serious complication of desmopressin (ddavp) for the treatment of primary monosymptomatic nocturnal enuresis (pmne). objectives: this study aimed to identify the incidence and risk factors of serum sodium (na) alterations in children with pmne treated with oral or intranasal ddavp. methods: a total of 201 patients with pmne were evaluated in 2 groups using intranasal (n = 127) or oral ddavp (n = 74) for approximately 6 months. treatment efficacy was defined as a more than 50% decrease in wet nights after 1 month of treatment. serum na was measured before, during, and after treatment in all patients. predisposing factors of serum na disturbance were evaluated concomitantly. results: the mean age of patients was 8.8 ± 2.6 (5 - 17.5) years, and males outnumbered females (m/f = 1.68). treatment efficacy was 100% in 93 (46.2%), and > 90% in 157 (78.1%) cases. oral ddavp had significantly more therapeutic effects than intranasal treatment (p = 0.024). however, serum na had no significant difference between the 2 groups (p = 0.52). hyponatremia occurred in 7 (3.5%) patients (3 in oral treatment and 4 in intranasal treatment; p = 0.73) with no significant correlation to age, gender, body weight, frequency of enuresis, and initial serum na. however, decreased serum na > 5 meq/l was a significant risk factor for the prediction of hyponatremia in our patients (p < 0.001). conclusions: oral ddavp had more therapeutic effects than intranasal treatment for the treatment of pmne. serum na had no significant alteration in both oral and intranasal treatments, and hyponatremia was a rare complication of ddavp, which occurred significantly in children with a > 5-meq/l decrease of initial serum na concentration. as a suggestion, monitoring serum na is not an essential follow-up in asymptomatic patients in ddavp treatment.