Desmopressin for Urinary Incontinence – Case Study

Firefly_elderly woman walking toward the restroom 980090

In this case study, I outline the use of desmopressin for urinary incontinence. It isn’t an order I see very often, but it is critical to remember the concerns of hyponatremia with this medication. Here’s the case;

ES is an 82-year-old female living in an assisted living facility. She has been struggling with urinary incontinence for several years. Staff reports that she often has accidents at night and needs frequent linen changes. Her past medical history includes depression, hypertension, edema, osteoarthritis, and mild cognitive impairment. Her current medication list includes:

Lisinopril 20 mg daily
Furosemide 20 mg every morning
Sertraline 50 mg daily
Acetaminophen 650 mg TID as needed
Calcium + Vitamin D
Donepezil 5 mg nightly

At her recent visit, her provider reviewed the clinical record, and it appears she did not tolerate a trial of oxybutynin for her urinary symptoms. She became increasingly confused while taking this medication. Her provider prescribes desmopressin for urinary incontinence at a dose of 0.1 mg daily at bedtime to try to reduce nighttime accidents.

Two weeks after initiation of desmopressin, ES was noted to be more confused than usual and had a fall. Lab work showed serum sodium of 124 mEq/L (previously 139). The desmopressin was immediately stopped, and she required hospitalization for hyponatremia management.

There are a few items I want to mention that increased her risk for hyponatremia. ES is an elderly patient who is taking a loop diuretic. Both of these are risk factors for hyponatremia. In addition, sertraline (an SSRI) is associated with SIADH and causing hyponatremia. Adding desmopressin for urinary incontinence to this patient’s regimen placed her at very high risk for hyponatremia. This medication carries a boxed warning for this concern and is definitely something that could come up on your board exams.

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