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Suggest treatment for nocturia

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Posted on Mon, 14 Jul 2014
Question: Yes please. I have a 98 year old female patient who is basically healthy, but she is troubled by Nocturia, 2-3 times a night, wets herself. Makes her really unhappy. question about using desmopressin for her. How will it affect her>
doctor
Answered by Dr. Rovena Murati (2 hours later)
Brief Answer:
She need a complete evaluation!

Detailed Answer:
Hello!
I read carefully your query and understand your concern.

Nocturia is a common condition in elderly.
Nocturia is often a symptom of other medical conditions including:

-Urological infection
-Diabetes Mellitus
-Diabetes Insipidus
-A tumor of the bladder
-Bladder prolapse
-Nephrotic Syndrome
-Obstructive sleep apnea,
-Neurologic conditions such as autonomic neuropathy
- Use of medications, such as diuretics and calcium channel blockers, and habits, such as excessive fluid intake.

Before starting a treatment she need a complete evaluation to exclude first these common medical conditions as a cause.

I suggest to consult a physician and get her examined.A carefully physical examination is important :
-Orthostatic vital signs should be obtained to evaluate for evidence of autonomic neuropathy.
-Evidence of heart failure should be sought.
-An abdominal examination may reveal a large distended bladder or evidence of fecal impaction
- A careful genitourinary examination should include a search for pelvic relaxation , detrusor dysfunction as manifested by a large postvoid residual, and evidence of neurologic deficits.

She also need to run some tests and investigations including:
-Blood sugar (To exclude Diabetes)
-Urinalysis (to exclude urinary tract infection)
-Evaluation of renal function
-Bladder Ultrasound before and after voiding


After have excluded the above possibilities , her treating doctor might prescribe a treatment.

She should minimize her fluid intake 6 hours before going to bed.
Desmopressin is generally well tolerated.
Possible side effects are headache, nausea, dizziness,peripheral edema,Hyponatremia.
If Desmopressin is prescribed , a careful and frequent monitoring of her serum electrolytes is needed.

So consult a physician and get her examined before starting the treatment with Desmopressin.


Hope my answer has helped.
Let me know If you have any further question,I will be happy to help.

Best Regards!

Dr.Rovena Murati

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rovena Murati (48 hours later)
This patient has been worked up - she is a thin frail 98 yo woman who does not have DM, or CHF her kidney function is good for a 98 yo person ,Creatinine of 0.7 her GFR is 77.3. Her random glucose is 73. The only seriously low finding is her serum albumin of 2.8.
She has a very distant hx of a pre malignancy in her stomach which was partially resected many years ago and has not given her any trouble since.
She has a pacemaker, and IBS.
She walks with a cane.
The only complaint she has is nocturia 2 to 3 times a night. THe reason I have contacted you is because I am not familiar with using desmopressin and of course since she is 98 yrs old I do not want to put her into failure. I basically wanted to know if it is safe to use on this lady if I give her a very low dose.
I am sorry if I wasn't as clear as I should have been
She doesn't have a UTI and does not have abnorma findings in her urine.
doctor
Answered by Dr. Rovena Murati (17 hours later)
Brief Answer:
You can start a low dose of Desmopressin.

Detailed Answer:
Hello again!
Sorry for the delay!

You can use Desmopressin in a low oral dose (0.1–0.4 mg) at bedtime and monitoring her serum electrolytes.
If she has no improvement it would be prudent to refer her to a Urologist/Gynecologist and get her examined.
She need a evaluation of her urinary tract.
-genitourinary examination should include a search for pelvic relaxation , detrusor dysfunction and evidence of neurologic deficits.
- uroflometry and Urodynaemic study to evaluate bladder function
-Cystoscopy

Only after exact diagnosis treatment can be suggested .

Hope it has helped.
Wish you all the best.

Dr.Rovena
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Rovena Murati

General & Family Physician

Practicing since :2013

Answered : 1243 Questions

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Suggest treatment for nocturia

Brief Answer: She need a complete evaluation! Detailed Answer: Hello! I read carefully your query and understand your concern. Nocturia is a common condition in elderly. Nocturia is often a symptom of other medical conditions including: -Urological infection -Diabetes Mellitus -Diabetes Insipidus -A tumor of the bladder -Bladder prolapse -Nephrotic Syndrome -Obstructive sleep apnea, -Neurologic conditions such as autonomic neuropathy - Use of medications, such as diuretics and calcium channel blockers, and habits, such as excessive fluid intake. Before starting a treatment she need a complete evaluation to exclude first these common medical conditions as a cause. I suggest to consult a physician and get her examined.A carefully physical examination is important : -Orthostatic vital signs should be obtained to evaluate for evidence of autonomic neuropathy. -Evidence of heart failure should be sought. -An abdominal examination may reveal a large distended bladder or evidence of fecal impaction - A careful genitourinary examination should include a search for pelvic relaxation , detrusor dysfunction as manifested by a large postvoid residual, and evidence of neurologic deficits. She also need to run some tests and investigations including: -Blood sugar (To exclude Diabetes) -Urinalysis (to exclude urinary tract infection) -Evaluation of renal function -Bladder Ultrasound before and after voiding After have excluded the above possibilities , her treating doctor might prescribe a treatment. She should minimize her fluid intake 6 hours before going to bed. Desmopressin is generally well tolerated. Possible side effects are headache, nausea, dizziness,peripheral edema,Hyponatremia. If Desmopressin is prescribed , a careful and frequent monitoring of her serum electrolytes is needed. So consult a physician and get her examined before starting the treatment with Desmopressin. Hope my answer has helped. Let me know If you have any further question,I will be happy to help. Best Regards! Dr.Rovena Murati