Endocrine Abstracts

Introduction: Desmopressin is a synthetic analogue of anti-diuretic hormone (ADH) used in the management of arginine vasopressin deficiency (AVP-D) and arginine vasopressin resistance (AVP-R). Omission or delay of desmopressin in patients with AVP-D can result in life-threatening dehydration and hypernatremia, as highlighted in the 2016 NHS England Patient Safety Alert.

Objectives: To evaluate prescribing and monitoring practices for patients with AVP-D and AVP-R at a district general hospital in North West London.

Methods: This was a retrospective evaluation of all adult inpatients (≥18 years) prescribed desmopressin for AVP-D or AVP-R between January and November 2024 across all LNWUH sites. Data were collected from Cerner electronic health records and analysed in Microsoft Excel. The following practices were evaluated: prevalence of daily fluid balance monitoring, daily sodium measurement daily weight measurement, and timely administration of desmopressin without omission [3].

Results: Eighteen patients met the inclusion criteria. Seventeen patients were established on desmopressin prior to admission; one was newly initiated. 65% (n = 11) of patients previously on desmopressin were prescribed on admission. Fluid balances were recorded daily in 22% (n = 4) of patients. Sodium levels were checked daily in 28% (n = 5) patients. At least one delayed dose was observed in 56% (n = 10) patients, and one or more omitted dose was observed in 44% (n = 18) patients.

Conclusion: This audit highlights significant gaps in desmopressin prescribing and monitoring. Despite 24-hour stock availability the criticality of desmopressin has potentially not been realised as demonstrated by the dose omissions in this evaluation. Lack of awareness of AVP disorders as life-threatening conditions may contribute to inadequate prioritisation. Key recommendations include improving multidisciplinary and patient awareness, reinforcing out-of-hours access processes, and ensuring desmopressin is available in high-use areas.