Systematic Use of DDAVP to Prevent Serum Sodium Overcorrection in Severe Hyponatremia

Exclusion Criteria22

• Obvious increase of extracellular fluid volume (cirrhosis with ascites, congestive heart failure, nephrotic syndrome);
• Hyponatremia caused by hyperglycaemia (> 30 mmol/L) or hypertriglyceridemia (10 g/L) or hyperproteinaemia (120 g/L)
• Severe acute kidney injury (KDIGO 3)
• Severe chronic kidney disease (eGFR <20 ml/min)
• Coronary patients well stabilized with trinitrine-based medicines
• Recent neurosurgery or traumatic brain injury
• Previous DDAVP or hypertonic fluid administration for the current episode of severe hyponatremia
• SNa increased by 5 mmol or more between admission at hospital and randomisation (H0)
• Known contraindication to DDAVP
• Allergy
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• History of unstable angina and/or known or suspected heart failure.
• Willebrand disease type IIB
• Severe previous neurologic disability (Glasgow Outcome Scale: GOS < 3)
• Diabetes insipidus receiving DDAVP treatment
• Moribund state (patient likely to die within 24h)
• Need for invasive mechanic ventilation
• Enrolment to another interventional study (clinical trial on medicinal product, medical device and interventional research involving human participants not concerning health product)
• Pregnancy or breastfeeding
• Subject deprived of freedom, subject under a legal protective measure
• No affiliation to any health insurance system
• Refusal to participate to the study (patient or legal representative or family member or close relative if present)