(981) Effect of Desmopressin on Attaining Hypernatremia With Hypertonic Saline in Intracranial Hemorrhage

Introduction: Platelet dysfunction in the setting of intracranial hemorrhage may potentiate worsening hemorrhage. Desmopressin (DDAVP) may be considered to treat platelet dysfunction; however, efficacy has not been established. Hypertonic saline may be utilized in this population to treat cerebral edema and elevated intracranial pressure. Free water reabsorption associated with DDAVP may attenuate the effect of hyperosmolar therapy. The effect of DDAVP on continuous infusion hypertonic saline when targeting a specific sodium goal has not been definitively elucidated, with some evidence suggesting a lower likelihood of attaining a sodium goal when targeting a higher goal such as 150 to 155 mEq/L. We hypothesize a lower proportion of patients will attain a sodium goal of 150 mEq/L or greater within 48 hours in patients who receive DDAVP compared to those that did not.

Methods: This is a retrospective cohort study including patients presenting with intracranial hemorrhage that received sodium chloride 3% continuous infusion titrated to a sodium goal of 150 to 155 mEq/L for at least 48 hours, comparing patients who did not receive DDAVP to those that did. The primary endpoint is the proportion of patients reaching a sodium goal of at least 150 mEq/L within 48 hours of hypertonic saline initiation, tested using the Chi-Square test. To account for confounding variables, a logistic regression adjusted analysis was also performed. Goal attainment at earlier time points were also compared.

Results: One hundred twenty-seven patients were included in this study, 75 did not receive DDAVP and 52 did. The goal sodium of 150 mEq/L or greater was achieved within 48 hours of hypertonic saline initiation in 47 (62.7%) patients that did not receive DDAVP versus 34 (65.4%) patients that received DDAVP (p = 0.3881). Adjusted analysis evaluating the effect of DDAVP on sodium goal attainment did not result in statistical significance (odds ratio = 2.82 (95% confidence interval = 0.63 - 12.73); p = 0.1768). No difference was observed in the attainment of the sodium goal at earlier time points prior to 48 hours.

Conclusions: DDAVP does not appreciably impact the ability to attain a sodium goal greater than or equal to 150mEq/L when administered with continuous infusion hypertonic saline.