Scientific letter
Levetiracetam can decrease desmopressin requirement in children with diabetes insipidus
El levetiracetam puede disminuir la dosis de desmopresina en niños con diabetes insípida
Cristina García Pérez, Emilio García García
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Unidad de Pediatría, Sección de Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Universitario Virgen del Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El levetiracetam puede disminuir la dosis de desmopresina en niños con diabetes insípida" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hyponatremia due to water intoxication is a known adverse effect of antiepileptic drugs, particularly carbamazepine and oxcarbazepine. The postulated mechanisms are an increase in hypothalamic antidiuretic hormone (ADH) secretion on one hand, and increased action of the hormone at renal tubular level on the other.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Levetiracetam is a second-generation anticonvulsant that is increasingly prescribed because it has fewer side effects than the classical agents, also in pediatric patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a girl with no relevant family or personal history diagnosed at three years of age with sellar craniopharyngioma after consulting for headache. Initial management consisted of partial surgical resection. Following this first treatment, she developed growth hormone deficiency as sole complication; replacement therapy was not prescribed, due to the persistence of tumor remnants. At 6 years of age the patient developed cranial hypertension due to growth of the neoplasm, requiring repeat surgery to secure complete resection. At that time her anthropometric data were: weight 16 kg, height 101 cm (−3.13 standard deviations below average), body mass index 16.5 kg/m<span class="elsevierStyleSup">2</span> (percentile 59) and body surface area 0.69 m<span class="elsevierStyleSup">2</span>. In this second postoperative period the patient presented panhypopituitarism including central diabetes insipidus, as well as adipsia, obstructive hydrocephalus, behavioral disorders, and cognitive, vision and motor deficits (paresis and spasticity of the left extremities). She was receiving treatment with hydrocortisone 2.5 mg/8 h p.o., levothyroxine 62.5 μg/24 h p.o. and desmopressin 5 μg/12 h via the nasal route in the event of diuresis >50 ml/h. The management of water-electrolyte metabolism was complicated by the cognitive problems and lack of thirst sensation. The parents were therefore instructed to provide a fixed water supply of 1300 ml/day to cover the basal needs and to immediately replace losses, and the blood sodium levels were closely monitored.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the sixth month after surgery, the patient suffered seizures apparently not related to sodium plasma changes; these episodes were attributed to the treatment with levetiracetam 20 mg/kg/day p.o. in two doses. Diuresis was seen to decrease from the first day of administration of the drug. Following our instructions, the parents therefore discontinued desmopressin. Over the following days the patient experienced mild polyuria (50−70 ml/h) that was controlled with a small dose of intranasal desmopressin (0.6 μg/12 h, i.e., much less than the previous dose of 5 μg/12 h). This treatment is currently maintained, 24 months after surgery.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We confirmed the immediate antidiuretic action of levetiracetam, as occurs with other antiepileptic drugs. There have been some reports to date of this effect in adults, but not in children.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–8</span></a> In patients with diabetes insipidus, such treatment decreases polyuria and reduces the need for antidiuretic medication. There have been reports of patients treated with desmopressin who show a decrease in need for the drug on adding carbamazepine<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and lamotrigine,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> though we have found no such reports in relation to this new anticonvulsant.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although levetiracetam is less toxic than the conventional antiepileptic drugs, it does exert a certain antidiuretic effect in patients, including children. We need to be aware of this potential effect of the drug. At the start of administration there is a risk of hyponatremia due to water intoxication, and in individuals with diabetes insipidus, diuresis should be monitored more closely, with desmopressin dose reduction if needed.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García Pérez C, García García E. El levetiracetam puede disminuir la dosis de desmopresina en niños con diabetes insípida. Endocrinol Diabetes Nutr. 2019;66:663–664.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyponatremia induced by antiepileptic drugs in patients with epilepsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "X. Lu" 1 => "X. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 2 | 6 |
| 2024 October | 19 | 16 | 35 |
| 2024 September | 47 | 25 | 72 |
| 2024 August | 35 | 23 | 58 |
| 2024 July | 19 | 8 | 27 |
| 2024 June | 20 | 11 | 31 |
| 2024 May | 24 | 7 | 31 |
| 2024 April | 11 | 6 | 17 |
| 2024 March | 24 | 8 | 32 |
| 2024 February | 30 | 4 | 34 |
| 2024 January | 36 | 10 | 46 |
| 2023 December | 32 | 4 | 36 |
| 2023 November | 33 | 10 | 43 |
| 2023 October | 42 | 11 | 53 |
| 2023 September | 28 | 5 | 33 |
| 2023 August | 36 | 6 | 42 |
| 2023 July | 33 | 7 | 40 |
| 2023 June | 33 | 7 | 40 |
| 2023 May | 86 | 15 | 101 |
| 2023 April | 96 | 8 | 104 |
| 2023 March | 81 | 9 | 90 |
| 2023 February | 35 | 5 | 40 |
| 2023 January | 29 | 2 | 31 |
| 2022 December | 28 | 8 | 36 |
| 2022 November | 35 | 6 | 41 |
| 2022 October | 23 | 9 | 32 |
| 2022 September | 36 | 12 | 48 |
| 2022 August | 26 | 9 | 35 |
| 2022 July | 19 | 15 | 34 |
| 2022 June | 18 | 7 | 25 |
| 2022 May | 22 | 11 | 33 |
| 2022 April | 21 | 9 | 30 |
| 2022 March | 27 | 21 | 48 |
| 2022 February | 32 | 17 | 49 |
| 2022 January | 83 | 15 | 98 |
| 2021 December | 69 | 16 | 85 |
| 2021 November | 61 | 22 | 83 |
| 2021 October | 33 | 24 | 57 |
| 2021 September | 29 | 25 | 54 |
| 2021 August | 52 | 21 | 73 |
| 2021 July | 34 | 15 | 49 |
| 2021 June | 39 | 15 | 54 |
| 2021 May | 31 | 11 | 42 |
| 2021 April | 70 | 13 | 83 |
| 2021 March | 56 | 7 | 63 |
| 2021 February | 31 | 7 | 38 |
| 2021 January | 22 | 12 | 34 |
| 2020 December | 20 | 17 | 37 |
| 2020 November | 16 | 9 | 25 |
| 2020 October | 7 | 5 | 12 |
| 2020 September | 15 | 9 | 24 |
| 2020 August | 19 | 18 | 37 |
| 2020 July | 13 | 10 | 23 |
| 2020 June | 6 | 7 | 13 |
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