Letter to the Editor
Hypertensive pulmonary edema related to desmopressin acetate
Edema pulmonar hipertensivo relacionado con el acetato de desmopresina
Ummu Korkmaz, Erol Demir
, Halil Yazici, Mehmet Sukru Sever
Corresponding author
Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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"Demir" "email" => array:1 [ 0 => "eroldemir83@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Halil" "apellidos" => "Yazici" ] 3 => array:2 [ "nombre" => "Mehmet Sukru" "apellidos" => "Sever" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Edema pulmonar hipertensivo relacionado con el acetato de desmopresina" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Desmopressin acetate, known as DDVAP (1-deamino-8-<span class="elsevierStyleSmallCaps">d</span>-arginine vasopressin), increases factors VIII and vWF, shortens activated partial thrombin time and bleeding time. Desmopressin is the best treatment in emergency situation, increases the release of the von Willebrand factor from the endothelium in uremic bleeding.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Potential side effects of desmopressin include headache, nausea, malaise, hypotension, facial flushing, tachycardia, dizziness and hyponatremia.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> However hypertension weren’t defined before, we present two cases of hypertensive pulmonary edema after the infusion of desmopressin prior to ultrasound (USG) guided percutaneous kidney biopsy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 49 year-old female with end-stage renal failure secondary to unknown etiology received a living-donor transplant 3 years ago, was scheduled to have a transplant biopsy due to deteriorating graft function. Blood pressure was 160/90<span class="elsevierStyleHsp" style=""></span>mmHg, pulse was 72<span class="elsevierStyleHsp" style=""></span>beats/min, and respiratory rate was 14<span class="elsevierStyleHsp" style=""></span>breaths/min.</p><p id="par0015" class="elsevierStylePara elsevierViewall">She was given an infusion of 15<span class="elsevierStyleHsp" style=""></span>μg of intravenous DDAVP over 20<span class="elsevierStyleHsp" style=""></span>min in preparation for biopsy. Biopsy performed without complications. After 40<span class="elsevierStyleHsp" style=""></span>min from the infusion; the patient suffers from dyspnea. Her blood pressure elevated to 220/140<span class="elsevierStyleHsp" style=""></span>mmHg. On examination there was crepitation on the both lungs on every area. SPO2 was 70 on the pulse oximeter.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Respiratory rate was elevated to 40. Immediately she was given furosemide and nitroglycerin infusion with oxygen. Her SPO2 levels elevated after the treatment. She was monitoring all day and her blood pressure fall to 140/80 after 8<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 42 year-old male with crescentic IgA nephropathy, who was diagnosed 7 months ago, was treated with pulse steroid and cyclophosphamide for induction. On examination, the patient was relieve, body temperature was 36.6<span class="elsevierStyleHsp" style=""></span>C, blood pressure was 150/90<span class="elsevierStyleHsp" style=""></span>mmHg, pulse was 72<span class="elsevierStyleHsp" style=""></span>beats/min, and respiratory rate was 14 breaths/min.</p><p id="par0030" class="elsevierStylePara elsevierViewall">He was given an infusion of 15<span class="elsevierStyleHsp" style=""></span>μg of intravenous DDAVP over 20<span class="elsevierStyleHsp" style=""></span>min in preparation for biopsy. Biopsy performed without complications. After 2<span class="elsevierStyleHsp" style=""></span>h from the infusion; the patient suffers from dyspnea. His blood pressure elevated to 230/120<span class="elsevierStyleHsp" style=""></span>mmHg. He was treated with oxygen, furosemide and nitroglycerin. His blood pressure was 150/90<span class="elsevierStyleHsp" style=""></span>mmHg after 8<span class="elsevierStyleHsp" style=""></span>h of intense therapy. His oxygen saturation had risen to 98 from 75 on room air.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Both of cases didn’t have any history of coronary heart disease or heart failure but they have hypervolemia due to renal failure.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Hergesell et al. reported that risks in order to minimize, to adopt adequate biopsy technique is not only important, but also high-risk patients, especially uncontrolled blood pressure, with a clotting disorder, or has emphasized that it is necessary to exclude those unwilling to cooperate.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Mannucci et al. reported that prohibited for use in who have arterial disease. DDAVP related myocardial infarction and cerebrovascular disease has been reported to case presentations, can’t be used in patients with known cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">DDAVP was an analog of vasopressin, may provoke symptomatic hyponatremia because of water retention. According to the U.S. Food and Drug Administration Agency, the half-life of DDAVP in patients with severe renal impairment can be extend by 9<span class="elsevierStyleHsp" style=""></span>h. Therefore, patients should be advised to restrict fluid intake from 1<span class="elsevierStyleHsp" style=""></span>h before to 9<span class="elsevierStyleHsp" style=""></span>h after administration of DDAVP. Blood sodium control is proposed following use in hyponatremic patient.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There are no publications that specify the use of DDAVP in hypervolemic patient. In our cases DDAVP effected like vasopressin and increased water retention in the hypervolemic patients. In patients without structural heart disease DDAVP may have a role that could lead to hypertensive pulmonary edema. In our patients; increased blood pressure responded diuretic and vasodilator treatment.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Hypertension is not a limiting factor to evaluate the use of DDAVP because of falsely elevated blood pressure due to anxiety. We recommend careful use of DDAVP in hypertensive patients due to a hypervolemia without structural heart disease, and we think this situation could lead role in the hypertensive pulmonary edema.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Desmopressin acetate in percutaneous ultrasound-guided kidney biopsy: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Manno" 1 => "C. Bonifati" 2 => "D.D. Torres" 3 => "N. Campobasso" 4 => "F.P. 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Butler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anaesth Intensive Care" "fecha" => "2000" "volumen" => "28" "paginaInicial" => "199" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10788975" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000003/v1_201707070022/S2013251417301062/v1_201707070022/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000003/v1_201707070022/S2013251417301062/v1_201707070022/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301062?idApp=UINPBA000064" ]
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| 2021 March | 132 | 54 | 186 |
| 2021 February | 79 | 39 | 118 |
| 2021 January | 76 | 19 | 95 |
| 2020 December | 52 | 16 | 68 |
| 2020 November | 70 | 17 | 87 |
| 2020 October | 48 | 16 | 64 |
| 2020 September | 58 | 17 | 75 |
| 2020 August | 98 | 14 | 112 |
| 2020 July | 123 | 10 | 133 |
| 2020 June | 94 | 15 | 109 |
| 2020 May | 85 | 10 | 95 |
| 2020 April | 91 | 21 | 112 |
| 2020 March | 107 | 18 | 125 |
| 2020 February | 137 | 18 | 155 |
| 2020 January | 111 | 28 | 139 |
| 2019 December | 104 | 20 | 124 |
| 2019 November | 102 | 20 | 122 |
| 2019 October | 105 | 18 | 123 |
| 2019 September | 109 | 14 | 123 |
| 2019 August | 94 | 15 | 109 |
| 2019 July | 65 | 20 | 85 |
| 2019 June | 28 | 72 | 100 |
| 2019 May | 78 | 109 | 187 |
| 2019 April | 96 | 83 | 179 |
| 2019 March | 58 | 30 | 88 |
| 2019 February | 42 | 21 | 63 |
| 2019 January | 50 | 24 | 74 |
| 2018 December | 124 | 39 | 163 |
| 2018 November | 194 | 18 | 212 |
| 2018 October | 163 | 18 | 181 |
| 2018 September | 65 | 19 | 84 |
| 2018 August | 55 | 19 | 74 |
| 2018 July | 41 | 11 | 52 |
| 2018 June | 51 | 13 | 64 |
| 2018 May | 78 | 17 | 95 |
| 2018 April | 73 | 14 | 87 |
| 2018 March | 105 | 12 | 117 |
| 2018 February | 48 | 9 | 57 |
| 2018 January | 62 | 6 | 68 |
| 2017 December | 61 | 4 | 65 |
| 2017 November | 43 | 14 | 57 |
| 2017 October | 28 | 7 | 35 |
| 2017 September | 29 | 7 | 36 |
| 2017 August | 27 | 6 | 33 |
| 2017 July | 43 | 15 | 58 |
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