Renal effects of high dose desmopressin and dextran. A study in normal subjects and in patients undergoing total hip replacement.

Abstract

Dextran 70 and the haemostatically active vasopressin analogue desmopressin were administered to four healthy volunteers and to 12 patients undergoing total hip replacement. In volunteers the antidiuretic effect of a single i.v. dose of desmopressin (0.3 microgram/kg bodyweight) caused a mean net urine deficit, compared with controls, of 890 ml/24 h. Both drugs increased estimated blood volume, but only the combination caused an increase still persisting after 24 h (+530 ml). Desmopressin-treated surgical patients had the same urine volumes as controls, without the use of more diuretics or more i.v. fluid administration. Creatinine clearance was significantly increased postoperatively in patients on desmopressin, compared with controls. Thus the long-lasting antidiuretic effect of desmopressin seen in healthy volunteers was absent in surgical patients, possibly because there was a compensatory increase in glomerular filtration rate (creatinine clearance).