When to start DDAVP-HTS protocol?

Inclusion:

• Severe hypo-osmolar hypoNa patients in the ICU with Na lower than 120mmol/L

Exclusion:

• Profound renal failure
  • On CRRT
• If control of body volume status is significantly affected by other clinical factors e.g.
  • Volume overload e.g. pulmonary oedema
  • If large volume administration may be needed e.g.
    • Shock
    • Severe rhabdomyolysis
  • If volume depletion may be very high risk e.g. subarachnoid haemorrhage
• Patients in whom bolus hypertonic therapy has just been given
  • (because the rise in the following 24h subsequent to initial 3-6mmol/L from bolus hypertonic therapy should be minimal)
  • If not falling into other exclusion criteria, DDAVP clamp should still be used to avoid excessively rapid rise of Na after the initial bolus
  • Can start the protocol after the initial 24h has passed or if SNa rise after bolus hypertonic therapy isn't high enough