- 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
Effects of desmopressin on blood loss in hip arthroplasty. Controlled study in 50 patients.