HOT TOPICS: Desmopressin and Sodium Goals in Intracranial Hemorrhage

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, DO, welcomes back Andrew Webb, PharmD, to unpack "Effect of Desmopressin on Attaining Therapeutic Hypernatremia with Hypertonic Saline Continuous Infusion in Intracranial Hemorrhage," recently published in Neurocritical Care.

Desmopressin has become a familiar tool for blunting antiplatelet-associated bleeding in intracranial hemorrhage, but its vasopressin-receptor activity raises a concern. Does it work against efforts to raise sodium with hypertonic saline? Dr. Webb traces desmopressin's path from a 1970s antidiuretic drug for diabetes insipidus to a hemostatic agent borrowed from the hemophilia literature, then walks through its pharmacokinetics, typical hemostatic dosing and the relatively modest side-effect profile clinicians should watch for.

The conversation turns to a single-center retrospective study that paired a protocolized, TEG-guided desmopressin dose with a nurse-driven hypertonic saline sliding-scale infusion targeting a sodium goal of 150–155 mEq/L. Drs. Choi and Webb walk through how the study was designed and what it found, touching on sodium goal attainment, TEG changes, 3% saline volumes and thromboembolic risk. They also dig into the study's limitations, including its more conservative desmopressin dosing relative to practice at other centers, and agree a randomized trial is still needed to settle desmopressin's role in ICH management more broadly. For clinicians giving desmopressin alongside hypertonic saline, Dr. Webb offers a practical piece of advice worth tuning in for.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.