Signs of water intoxication/hyponatremia — headache, drowsiness, confusion, or seizures; report immediately.
Before you read
Test yourself first: 2 questions
Question 1 of 2
A client with central diabetes insipidus is prescribed desmopressin (DDAVP). Which finding indicates the medication is effective?
Answer: A. Desmopressin is a synthetic ADH analog. Effectiveness in DI is shown by decreased urine output, increased urine specific gravity and osmolality, relief of excessive thirst, and stabilization of serum sodium. Continued large dilute urine output would indicate inadequate treatment; water intoxication (hyponatremia) signals overdose.
Question 2 of 2
A client with central diabetes insipidus is prescribed desmopressin. Which finding indicates the medication is effective?
Answer: A. Desmopressin is a synthetic ADH analog used in central diabetes insipidus. Effectiveness is shown by decreased urine output, increased urine specific gravity (more concentrated urine), and normalization of serum sodium. Worsening polyuria would indicate ineffectiveness.
Keep the streak going with more questions like these, each with a full rationale.
What is desmopressin (ddavp)?
It promotes water reabsorption in the kidneys, decreasing urine output and concentrating the urine. It is also used for nocturnal enuresis and certain bleeding disorders (von Willebrand disease, mild hemophilia A). The main danger is water intoxication and hyponatremia.
Key points to remember
- Synthetic ADH that increases water reabsorption in the renal collecting ducts, reducing urine output in diabetes insipidus.
- Effectiveness is shown by decreased urine output, increased urine specific gravity, and decreased serum osmolality toward normal.
- Major adverse effect is water intoxication leading to hyponatremia (headache, confusion, seizures).
- Also used for von Willebrand disease and mild hemophilia A because it raises factor VIII and von Willebrand factor.
- Available intranasally, orally, subcutaneously, and IV; nasal route can be affected by congestion or rhinitis.
Nursing priorities
- Monitor strict intake and output, daily weight, and urine specific gravity to evaluate response.
- Monitor serum sodium and assess for signs of water intoxication (headache, confusion, lethargy).
- Restrict excessive fluid intake to prevent dilutional hyponatremia.
- Teach correct intranasal administration technique and timing.
Labs & values
Patient teaching
- Weigh yourself daily and report rapid weight gain.
- Report headache, confusion, drowsiness, or any seizure activity immediately.
- Do not drink large amounts of extra fluid; drink to satisfy thirst only.
- For nasal spray, clear nasal passages and use correct technique; report congestion that may reduce absorption.
- Carry medical identification and do not skip doses for diabetes insipidus.
Red flags: report now
- Signs of water intoxication/hyponatremia — headache, drowsiness, confusion, or seizures; report immediately.
- Sudden weight gain with decreased urine output — fluid overload; report now.
- Never encourage extra fluids beyond thirst, as overhydration causes dangerous hyponatremia.
References
Clinical references for this topic
