Treatment of Glypressin Induced Hypoglycaemia with Desmopressin Acetate (DDAVP)

Severe hyponatraemia is an important cause of mortality and morbidity both independently and subsequent to rapid correction when osmotic demyelination may occur 1. We report a case of severe iatrogenic hyponatraemia secondary to Glypressin. Treatment with intramuscular Desmopressin acetate (DDAVP) was necessary to deliver controlled normalisation of the serum sodium, which was not possible with hypertonic saline and fluid restriction alone. Case History A 45-year-old lady with Primary Biliary Cirrhosis was admitted with lethargy, she was anaemic and her haemoglobin 3.4g/dl. Bleeding oesophageal varices were diagnosed at endoscopy and she was commenced on intravenous esomeprazole, 6 hourly glypressin and ciprofloxacin prophylaxis. She became haemodynamically unstable and over 4 days received a total of 12.5L crystalloid fluid and 5 units of blood. Her serum sodium fell precipitously on the 5 th day of her admission to 120mmol/L, then 116mmol/L later tha