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Here comes the answer 65th! Help this bed-wetting stop!

Here comes the answer 65th! Help this bed-wetting stop!

Mrs. Funto obviously meant the vasopressin (antidiuretic hormone) analogue, Desmopressin. we turn to Martindale for a brief on this topic.

Involuntary discharge of urine during sleep, termed nocturnal enuresis (bed-wetting), is a normal occurrence in young children, but may persist in up to 5% by the age of 10 years. Nocturnal enuresis is defined as primary if there has never been a period of dryness for more than 6 months, and secondary if the child was dry for such a period before the onset of bed-wetting. Nonpharmacological approaches to treatment include bladder retention training, motivational therapy, and behaviour modification or conditioning therapy using moisture-sensitive alarms. Drug therapy may initially produce a more rapid response, but training and the use of alarms has generally appeared to be more effective and to have a lower relapse rate. Although preparations are available to treat children as young as 5 years of age the BNFC states that drug therapy is inappropriate for this age group, and that treatment is usually unnecessary for children under 7 years and in cases where the child and parents are not anxious about the bed-wetting; however, children over 10 years of age are usually considered to require prompt treatment. Drug therapy is probably most useful for intermittent use on special occasions such as sleeping away from home or when added to treatment in children who fail to respond to nonpharmacological methods alone. The long-term use of drugs for enuresis is controversial. Use of oral desmopressin at night can be effective in the short-term control of nocturnal enuresis and many now consider it to be the drug of choice in terms of safety. However, it should not be given when enuresis is due to polydipsia as desmopressin may provoke water intoxication and convulsions due to hyponatraemia. Tricyclic antidepressants have also been used and of these most experience has been with imipramine. Their mechanism of action in nocturnal enuresis is unclear. It may be partly the result of their antimuscarinic and antispasmodic actions. Antimuscarinics such as oxybutynin reduce uninhibited bladder contractions, but although they may be of benefit in diurnal enuresis they are rarely of benefit in nocturnal enuresis alone.
Source: Martindale 36th edition

Desmopressin is usually started at a dose of 0.2mg taken with or without food at bedtime. It may be increased to 0.4mg if need be. To prevent the water intoxication stated above, Water intake should be minimal an hour before taking the drug and up to 8hrs afterwards. Maximum duration of treatment is 3months. Dele will benefit most from the drug if he starts it on his first day in school so as to be able to protect him from embarrassment throughout the term which usually last 3months. Assessment for improvement can then be done when he is on holiday. Ability to achieve dryness throughout the drug free period is a positive sign.
If you missed the question click bed-wetting

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