Role of Desmopressin in the Critical Care Setting

Desmopressin acetate is a synthetic analogue of arginine vasopressin, an endogenous hormone synthesized by the hypothalamus and released from the posterior pituitary gland.^1–3  Endogenous arginine vasopressin release occurs as a physiologic response to increased serum osmolality, decreased blood volume, or decreased mean arterial pressure.¹  Arginine vasopressin exerts its effects through several vasopressin receptors located in various tissues in the body. Activation of the vasopressin receptor 1 in the vasculature results in vasoconstriction.²  Vasopressin works at this receptor and is commonly given in the intensive care unit (ICU) to increase mean arterial pressure.⁴  In contrast, activation of vasopressin receptor 2 in the kidneys leads to water reabsorption from urine.⁵  For this reason, arginine vasopressin is sometimes referred to as antidiuretic hormone. Desmopressin mimics the actions of antidiuretic hormone at this receptor subtype in the kidney, with 10 times greater antidiuretic activity and 1500 times...