A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide?
A. “Administer desmopressin while the suspension is cold.”
B. “Your condition isn’t chronic, so you won’t need to wear a medical identification bracelet.”
C. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”
D. “You won’t need to monitor your fluid intake and output after you start taking desmopressin.”
Correct Answer: C. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”
Desmopressin may not be absorbed if the intranasal route is compromised. Desmopressin administration can be utilized to distinguish between central vs. nephrogenic diabetes insipidus, with a positive response noted in central diabetes insipidus, meaning the kidneys respond appropriately to desmopressin with the expected concentration of the urine and increased reabsorption of fluids, resulting in eutonic urine.
Option A: The intranasal form of vasopressin is frequently a choice when administration occurs at home. Each spray typically dispenses 150 micrograms. The intranasal dosage is directly proportional to the weight of the patient, with patients weighing less than 50 kg prescribed one spray, or 150 micrograms, and patients over 50 kg prescribed 2 sprays, or 300 micrograms, every 12 to 24 hours. This form of the drug reaches peak levels in 60 to 90 minutes.
Option B: Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. As patients age, they should also be continually monitored for declining renal function, as the therapeutic index and clearance of the drug will change according to the renal function.
Option D: The client must continue to monitor fluid intake and output and receive adequate fluid replacement. Desmopressin is generally well-tolerated in most patients. There are a few instances where patients require monitoring for adverse effects of the drug. Patients receiving desmopressin need monitoring for the occurrence of hyponatremia.
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