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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Desmopressin acetate&#44; known as DDVAP &#40;1-deamino-8-<span class="elsevierStyleSmallCaps">d</span>-arginine vasopressin&#41;&#44; increases factors VIII and vWF&#44; shortens activated partial thrombin time and bleeding time&#46; Desmopressin is the best treatment in emergency situation&#44; increases the release of the von Willebrand factor from the endothelium in uremic bleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Potential side effects of desmopressin include headache&#44; nausea&#44; malaise&#44; hypotension&#44; facial flushing&#44; tachycardia&#44; dizziness and hyponatremia&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> However hypertension weren&#8217;t defined before&#44; we present two cases of hypertensive pulmonary edema after the infusion of desmopressin prior to ultrasound &#40;USG&#41; guided percutaneous kidney biopsy&#46;</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&#44; was scheduled to have a transplant biopsy due to deteriorating graft function&#46; Blood pressure was 160&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; pulse was 72<span class="elsevierStyleHsp" style=""></span>beats&#47;min&#44; and respiratory rate was 14<span class="elsevierStyleHsp" style=""></span>breaths&#47;min&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">She was given an infusion of 15<span class="elsevierStyleHsp" style=""></span>&#956;g of intravenous DDAVP over 20<span class="elsevierStyleHsp" style=""></span>min in preparation for biopsy&#46; Biopsy performed without complications&#46; After 40<span class="elsevierStyleHsp" style=""></span>min from the infusion&#59; the patient suffers from dyspnea&#46; Her blood pressure elevated to 220&#47;140<span class="elsevierStyleHsp" style=""></span>mmHg&#46; On examination there was crepitation on the both lungs on every area&#46; SPO2 was 70 on the pulse oximeter&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Respiratory rate was elevated to 40&#46; Immediately she was given furosemide and nitroglycerin infusion with oxygen&#46; Her SPO2 levels elevated after the treatment&#46; She was monitoring all day and her blood pressure fall to 140&#47;80 after 8<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 42 year-old male with crescentic IgA nephropathy&#44; who was diagnosed 7 months ago&#44; was treated with pulse steroid and cyclophosphamide for induction&#46; On examination&#44; the patient was relieve&#44; body temperature was 36&#46;6<span class="elsevierStyleHsp" style=""></span>C&#44; blood pressure was 150&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; pulse was 72<span class="elsevierStyleHsp" style=""></span>beats&#47;min&#44; and respiratory rate was 14 breaths&#47;min&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">He was given an infusion of 15<span class="elsevierStyleHsp" style=""></span>&#956;g of intravenous DDAVP over 20<span class="elsevierStyleHsp" style=""></span>min in preparation for biopsy&#46; Biopsy performed without complications&#46; After 2<span class="elsevierStyleHsp" style=""></span>h from the infusion&#59; the patient suffers from dyspnea&#46; His blood pressure elevated to 230&#47;120<span class="elsevierStyleHsp" style=""></span>mmHg&#46; He was treated with oxygen&#44; furosemide and nitroglycerin&#46; His blood pressure was 150&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg after 8<span class="elsevierStyleHsp" style=""></span>h of intense therapy&#46; His oxygen saturation had risen to 98 from 75 on room air&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Both of cases didn&#8217;t have any history of coronary heart disease or heart failure but they have hypervolemia due to renal failure&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Hergesell et al&#46; reported that risks in order to minimize&#44; to adopt adequate biopsy technique is not only important&#44; but also high-risk patients&#44; especially uncontrolled blood pressure&#44; with a clotting disorder&#44; or has emphasized that it is necessary to exclude those unwilling to cooperate&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Mannucci et al&#46; reported that prohibited for use in who have arterial disease&#46; DDAVP related myocardial infarction and cerebrovascular disease has been reported to case presentations&#44; can&#8217;t be used in patients with known cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">DDAVP was an analog of vasopressin&#44; may provoke symptomatic hyponatremia because of water retention&#46; According to the U&#46;S&#46; Food and Drug Administration Agency&#44; the half-life of DDAVP in patients with severe renal impairment can be extend by 9<span class="elsevierStyleHsp" style=""></span>h&#46; Therefore&#44; 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&#46; Blood sodium control is proposed following use in hyponatremic patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There are no publications that specify the use of DDAVP in hypervolemic patient&#46; In our cases DDAVP effected like vasopressin and increased water retention in the hypervolemic patients&#46; In patients without structural heart disease DDAVP may have a role that could lead to hypertensive pulmonary edema&#46; In our patients&#59; increased blood pressure responded diuretic and vasodilator treatment&#46;</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&#46; We recommend careful use of DDAVP in hypertensive patients due to a hypervolemia without structural heart disease&#44; and we think this situation could lead role in the hypertensive pulmonary edema&#46;</p></span>"
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Letter to the Editor
Hypertensive pulmonary edema related to desmopressin acetate
Edema pulmonar hipertensivo relacionado con el acetato de desmopresina
Ummu Korkmaz, Erol Demir
Corresponding author
eroldemir83@yahoo.com

Corresponding author.
, Halil Yazici, Mehmet Sukru Sever
Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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guided percutaneous kidney biopsy&#46;</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&#44; was scheduled to have a transplant biopsy due to deteriorating graft function&#46; Blood pressure was 160&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; pulse was 72<span class="elsevierStyleHsp" style=""></span>beats&#47;min&#44; and respiratory rate was 14<span class="elsevierStyleHsp" style=""></span>breaths&#47;min&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">She was given an infusion of 15<span class="elsevierStyleHsp" style=""></span>&#956;g of intravenous DDAVP over 20<span class="elsevierStyleHsp" style=""></span>min in preparation for biopsy&#46; Biopsy performed without complications&#46; After 40<span class="elsevierStyleHsp" style=""></span>min from the infusion&#59; the patient suffers from dyspnea&#46; Her blood pressure elevated to 220&#47;140<span class="elsevierStyleHsp" style=""></span>mmHg&#46; On examination there was crepitation on the both lungs on every area&#46; SPO2 was 70 on the pulse oximeter&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Respiratory rate was elevated to 40&#46; Immediately she was given furosemide and nitroglycerin infusion with oxygen&#46; Her SPO2 levels elevated after the treatment&#46; She was monitoring all day and her blood pressure fall to 140&#47;80 after 8<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 42 year-old male with crescentic IgA nephropathy&#44; who was diagnosed 7 months ago&#44; was treated with pulse steroid and cyclophosphamide for induction&#46; On examination&#44; the patient was relieve&#44; body temperature was 36&#46;6<span class="elsevierStyleHsp" style=""></span>C&#44; blood pressure was 150&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; pulse was 72<span class="elsevierStyleHsp" style=""></span>beats&#47;min&#44; and respiratory rate was 14 breaths&#47;min&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">He was given an infusion of 15<span class="elsevierStyleHsp" style=""></span>&#956;g of intravenous DDAVP over 20<span class="elsevierStyleHsp" style=""></span>min in preparation for biopsy&#46; Biopsy performed without complications&#46; After 2<span class="elsevierStyleHsp" style=""></span>h from the infusion&#59; the patient suffers from dyspnea&#46; His blood pressure elevated to 230&#47;120<span class="elsevierStyleHsp" style=""></span>mmHg&#46; He was treated with oxygen&#44; furosemide and nitroglycerin&#46; His blood pressure was 150&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg after 8<span class="elsevierStyleHsp" style=""></span>h of intense therapy&#46; His oxygen saturation had risen to 98 from 75 on room air&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Both of cases didn&#8217;t have any history of coronary heart disease or heart failure but they have hypervolemia due to renal failure&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Hergesell et al&#46; reported that risks in order to minimize&#44; to adopt adequate biopsy technique is not only important&#44; but also high-risk patients&#44; especially uncontrolled blood pressure&#44; with a clotting disorder&#44; or has emphasized that it is necessary to exclude those unwilling to cooperate&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Mannucci et al&#46; reported that prohibited for use in who have arterial disease&#46; DDAVP related myocardial infarction and cerebrovascular disease has been reported to case presentations&#44; can&#8217;t be used in patients with known cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">DDAVP was an analog of vasopressin&#44; may provoke symptomatic hyponatremia because of water retention&#46; According to the U&#46;S&#46; Food and Drug Administration Agency&#44; the half-life of DDAVP in patients with severe renal impairment can be extend by 9<span class="elsevierStyleHsp" style=""></span>h&#46; Therefore&#44; 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&#46; Blood sodium control is proposed following use in hyponatremic patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There are no publications that specify the use of DDAVP in hypervolemic patient&#46; In our cases DDAVP effected like vasopressin and increased water retention in the hypervolemic patients&#46; In patients without structural heart disease DDAVP may have a role that could lead to hypertensive pulmonary edema&#46; In our patients&#59; increased blood pressure responded diuretic and vasodilator treatment&#46;</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&#46; We recommend careful use of DDAVP in hypertensive patients due to a hypervolemia without structural heart disease&#44; and we think this situation could lead role in the hypertensive pulmonary edema&#46;</p></span>"
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