Protocolized proactive desmopressin plus 3% saline therapy for severe euvolemic hyponatremia in the wave of COVID-19: The local experience and the potential role of emergency departments

Background: Patients with severe euvolemic hyponatremia can be challenging to treat, and the COVID-19 pandemic has added to the complexity of the situation. Methods: Data were collected from all patients treated in a local intensive care unit (ICU) with the protocolized proactive desmopressin plus 3% saline (PD-3 S) approach in March 2022. Results: Six patients were treated with the protocol, whose initial serum sodium level (SNa) ranged from 98 to 108 mmol/L. SNa of one patient dropped further due to delayed initiation of protocolized PD-3 S because of access block. But otherwise, the protocol had been effective in achieving a controlled rise of SNa in all patients. No major complications have been observed, and the feedback from both medical and nursing staff was overall positive. Conclusion: This case series shows that the protocolized PD-3 S is safe and effective. This protocol is currently being used in two ICUs in our cluster. And our unit is currently working with the emergency department to initiate the protocol earlier, before ICU admission.