Desmopressin before colonoscopy can lead to hyponatremia: BMC Case Report

A new case study published in BMC Nephrology suggests Clinicians be aware that the use of desmopressin, a significant risk factor for hyponatremia in addition to the use of a few well-known drugs and the presence of comorbidities.

Preparing the bowel for a colonoscopy is often regarded as a safe procedure. During bowel preparation, hyponatremia is a problem that has been documented in the literature. The majority of people who experience severe symptoms of hyponatremia are elderly and have other medical conditions including chronic kidney disease, hypothyroidism, or adrenal insufficiency. This potentially lethal complication, nevertheless, can also result from other processes and situations.

This case report by Ting-Hsuan Chiang and colleagues demonstrates a rare occurrence of a patient who experienced an acute hyponatremia-related seizure prior to a colonoscopy without experiencing any well-known risk factors. The usage of desmopressin was thought to have led to this significant consequence, which was later diagnosed as water intoxication.

A colonoscopy was scheduled for a 72-year-old man after a colonic lesion was identified accidentally during a regular health check two months before. The patient was aware, oriented, and denied any discomfort during the morning visit on the day of the colonoscopy. However, during anesthetic evaluation before the surgery, he was discovered to be sluggish and confused. The patient experienced a tonic-clonic seizure that lasted roughly one minute. He was sent to the critical care unit for additional assessment after a quick intubation.

Based on his medical history, the patient had benign prostate hyperplasia with considerable complaints of urine frequency and nocturia. Brain computed CT revealed no evidence of a space-occupying lesion or hemorrhage. According to the patient, he was concerned before the colonoscopy and wanted to make sure he had enough stool preparation by drinking a lot of water in addition to his bowel preparation routine. On the morning of the planned assessment, he reported a total water consumption of 5.5 L. With his medication history, high water intake, and low urine osmolality, the patient's severe hyponatremia was thought to be caused by desmopressin-induced water intoxication.

In conclusion, acute hyponatremia as a result of bowel preparation is an uncommon but significant consequence that should not be overlooked. Elevated serum ADH levels are frequently important in the setting of water intoxication. Ensuring enough electrolyte intake during bowel preparation and thorough patient education are especially important for people who are prone to water intoxication.

Reference:

Chiang, T.-H., Tan, J.-H., Chang, C.-C., & Fang, K.-C. (2022). Seizure from water intoxication following bowel preparation: a case report. In BMC Nephrology (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12882-022-03035-8