Optimizing Bed-Wetting Medication Management in Hospitalized Children
Questions will come up about how to address kids’ home bed-wetting meds during admission. Have a plan to optimize safe transitions.
In general, the benefits of continuing meds for bed-wetting during illness don’t outweigh the risks. Emphasize these meds are NOT a cure, and only temporarily reduce symptoms. But don’t be surprised if some families want to continue meds for less-acute admissions (observation, etc), since bed-wetting can be distressing for some patients. If ordered, expect desmopressin tabs to be used first line for kids age 6 and up. Doses range from 0.2 to 0.6 mg nightly, and the tabs can be split or crushed if patients can’t swallow them whole.
Avoid substituting with desmopressin nasal spray if you don’t carry the tabs, it’s easy for kids to get too much and develop hyponatremia. Look into using the patient’s home tab supply, if possible. Watch desmopressin scheduling if it’s continued during admission, to allow time for absorption. Confirm home admin timing with caregivers and schedule doses 1 hour before bed.
Monitor fluids while using desmopressin to avoid hyponatremia. Keep IV and po intake below 200 mL from 1 hr before to 8 hr after a dose. Similarly, advocate holding desmopressin when fluids are needed for patients with dehydration risks such as vomiting, diarrhea, or fevers. Recommend checking sodium labs if there are concerns for hyponatremia symptoms (headache, fatigue, etc). Anticipate seeing some kids also on anticholinergic meds, such as oxybutynin or imipramine, if they don’t respond to desmopressin. Oxybutynin may also be used for urinary urgency or daytime wetting.
Focus on the risks and benefits of continuing these meds while admitted. For example, anticholinergics can worsen dry eyes and mouth, constipation, or even arrhythmias. But abruptly stopping imipramine can also cause withdrawal symptoms (nausea, headache, etc). Ensure held meds are restarted on discharge, if appropriate. But clarify with families to continue holding desmopressin at home until nausea, vomiting, or diarrhea completely resolves.
References
- Harris J, Lipson A, Dos Santos J. Evaluation and management of enuresis in the general paediatric setting. Paediatr Child Health. 2023 Sep 23;28(6):362-376.
- Nevéus T, Fonseca E, Franco I, et al. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol. 2020;16(1):10-19.
- Walker RA. Nocturnal Enuresis. Prim Care. 2019;46(2):243-248.
