Serum sodium and intracranial pressure changes after desmopressin therapy in severe traumatic brain injury patients: a multi-centre cohort study

Annals of Intensive Care

Table 2 Clinical and biochemical data before desmopressin administration, at the time of desmopressin administration and after starting desmopressin

Variable	Value
Before desmopressin administration
Natremia 24 h preceding desmopressin, mmol/L	145 [141–150]
Natremia 12 h preceding desmopressin, mmol/L	147 [143–152]
Day of desmopressin administration
Natremia, mmol/L	153 [148–158]
Increase in natremia (compared to 24 h prior), mmol/L	7 [4–12]
Increase in natremia over 12 h preceding diagnosis, mmol/L	5 [2–9]
24-h diuresis, mL	4430 [3506–5317]
24-h urine output, mL/kg/h	2.5 [2.0–2.9]
Desmopressin use
Number of days with desmopressin	1 [1–3]
1st day desmopressin dose, μg	1 [0.5–2.0]
Total desmopressin dose, μg	2 [1–4]
Natremia changes after desmopressin
Proportion of patients with natremia corrected down to 145 mmol/L, n (%)	23 (59)
Time to normalize natremia, hours^a	36 [12–86]
Change in natremia after treatment, mmol/L^b	− 3 [− 9 to 0]
Rate of change of natremia after treatment, mmol/L/h	− 0.1 [− 0.2 to 0.0]
Fast correction of hypernatremia
Proportion of time with > 0.5 mmol/L/hr decrease in natremia, n (%)^c	31/341 (9%)
Proportion of time with > 1 mmol/L/hr decrease in natremia, n (%)^c	11/341 (3%)
Worsening of hypernatremia
Patients with natremia increase 12 h after starting desmopressin, n (%)	3/39 (8%)
Patients with natremia increase 24 h after starting desmopressin, n (%)	10/39 (26%)
Effect of natremia changes on ICP
Change in mean ICP after 24 h, mmHg	0 [− 3 to + 4]
Change in maximum ICP, mmHg^d	0 [− 8 to + 11]
Use of osmotherapy in the 48 h following desmopressin, n (%)	12 (31)

ICP intracranial pressure. Data are reported as median [interquartile ranges] or n (proportion)
^aTime to reach a natremia of 145 mmol/L or last natremia before loss of follow-up (death or 7 days)
^bThe change in natremia was calculated as the difference between natremia the day desmopressin was given and the lowest natremia after the start of treatment (censored by death, loss of follow-up or natremia of 145 mmol/L)
^cRate of natremia correction was assessed 6 hourly meaning that we screened 341 6-h time periods in 39 patients receiving desmopressin
^dThe maximum ICP 24 h before desmopressin was compared to the maximum ICP 24 h after desmopressin