Haemostasis and beyond: The expanding role of desmopressin in intensive care

Table 3 Dosing and monitoring of desmopressin in intensive care unit indications

Clinical Indication	Desmopressin dose and route	Frequency/duration	Monitoring/notes
Uremic bleeding (end-stage renal disease)	0.3 µg/kg IV (approximately 20-30 µg)	Single dose; may repeat in 24 hours with caution	Check bleeding time or PFA-100 if available; effect begins in approximately 1 hour, lasts 6-8 hours. Implement fluid restriction for 12-24 hours post-dose
Antiplatelet-associated intracerebral hemorrhage	0.4 µg/kg IV (max approximately 30 µg)	One-time dose at presentation	Administer promptly upon confirmation of hemorrhage. Monitor blood pressure during infusion (risk of hypotension). Reassess hematoma size on imaging. No routine repeat dosing
Trauma-induced coagulopathy (suspected platelet dysfunction/vWD)	0.3 µg/kg IV	Single dose early during resuscitation	Indicated for patients on antiplatelet agents or with known vWD. Incorporate into massive transfusion protocols. Monitor bleeding parameters (e.g., TEG/ROTEM). Not for empirical use
Inherited von Willebrand disease (type 1 and select type 2)	0.3 µg/kg IV/SC or 300 µg intranasal (150 µg/nostril)	Single dose; repeat in 12-24 hours if needed (max 2-3 doses)	Verify normal serum sodium before administration. Trial dose recommended to confirm responsiveness. Ineffective in Type 3 vWD—use vWF concentrate instead. Monitor vWF: FVIII levels if possible
Qualitative platelet dysfunction (e.g., CPB, liver disease)	0.3 µg/kg IV	One-time dose as needed for diffuse bleeding	Use in microvascular bleeding when platelet count is adequate but function impaired. Observe bleeding control (e.g., chest drain output). Consider adjunctive use of TXA
Central diabetes insipidus	1-2 µg IV/SC (fixed dose)	q8-12h; titrate based on clinical response	Monitor urine output hourly, urine specific gravity, and serum sodium every 4-6 hours. Adjust dose to maintain balanced output and stable sodium. Reduce or pause if sodium drops rapidly. Transition to oral/intranasal forms when stable

All doses should be adjusted in renal impairment carefully - desmopressin clearance is reduced, prolonging effect. IV: Intravenous; SC: Subcutaneous; IN: Intranasal; PRN: As needed; TXA: Tranexamic acid; UOP: Urine output; ROTEM: Rotational Thromboelastometry; TEG: Thromboelastography; vWF: Von Willebrand factor; vWD: Von Willebrand disease.