- For Diabetes Insipidus (intranasal & parental); bleeding due to hemophilia
A and Type I von Willebrand's dz (parental); bleeding from esophageal
varices; head trauma;
- it can transiently correct the bleeding time in most patients with
chronic renal failure and other acquired disorders of platelet function;
- DI: Intranasally: Adult: 0.1-0.4 mL (10-40 ug) daily in 2-3 divided doses;
- Peds: (3 mo-12yr): 0.05-0.3ml qd in 2-3 divided doses;
- Parentally: Adult: 0.5-1.0 ml (2-4 ug) qd in 2-3 DD; if converting from
intranasal to parental doseing, use 1/10th intranasal dose;
- Hemophilia A and von Willebrand's dz (Type I):
Adults and Peds: > 10 kg:
0.3 ug/kg diluted to 50 ml with NSS infused slowly over 15-30 min;
- Peds < 10 kg: same as above with dilution to 10 ml with NS;
- Bleeding from esophageal varices: IV infusion of 0.2-0.4 U/min with max
rate of 0.9 u/min;
- Note: in vary young and old patients, adjust fluid intake to avoid water
intoxication;
Synthetic Arginine Vasopression (DDAVP)
Indications: Diabetes insipidus (intranasal and parental); bleeding due
to Hemophilia A and Type I Von Willebrand's disease
(parental); Bleeding from esophageal varices; Head Trauma;
Dosage: DI: Intranasal: Adult: 0.1 - 0.4 ml (10-40 ug) qd in 2-3 DD;
Parental
: Adult: 0.5 - 1.0 ml (2-4 ug) qd in 2-3 DD;
Hemophilia: Adult: 0.3 ug/kg diluted to 50 ml w/ NS
infused slowly over 20 min.
Von Wille's Same as above:
Esophageal Bleeding: IV: 0.2-0.4 U/min; Max: 0.9 u/min;
- Note: avoid Water Intoxication and Hyponatremia;
- although desmopressin therapy is usually well tolerated, it does carry
small risk of serious complications, particularly in association with
hyponatremia in infants and arterial thrombosis in elderly patients;
- Renal Failure: Patients:
- bleeding of uremic patients can be shortened by administration of
conjugated estrogens or DDAVP, reinforcing speculation that inter-
action between platlets and factor VIII and vWF is the primary hemo-
static defect in uremia;
- in some uremic patients, prolonged bleeding times can be markedly
shortened
by simply raising the hematocrit;
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Desmopressin decreases operative blood loss in spinal cord injury
patients having flap reconstruction of pelvic pressure sores.
Effects of desmopressin on blood loss in hip arthroplasty. Controlled
study in 50 patients.
