NOCTURNAL EMESIS Flashcards
Nocturnal emesis
Involuntary urination during sleep
common in children
Children under 5
Should resolve without intervention
What age should treatment be given?
> 7yrs
Symptoms may still persist in small proportion by 10 yrs
Non drug treatment
Advice on fluid intake, diet, toileting behaviour, and use of reward systems
No response to advice (more than 1-2 wet beds per week) -
enuresis alarm
Alarms in <7 years given depending on maturity, motivation and understanding
Alarms have less relapse than drug treatment when discontinued
When do you review alarm?
Review alarm after 4 weeks
Continue until a minimum of 2 weeks of uninterrupted dry nights
If alarm treatment is unsuccessful:
add in / replace with desmopressin
When is desmopressin offered?
over 5
alarm is undesirable
needing rapid results
Drug treatment (children over 5)
Desmopressin
When do you assess treatment of desmopressin
after 4 weeks
continue for 3 months if pt is responding
repeated courses should be withdrawn gradually at regular intervals
Specialist drug treatment
desmopressin +/- antimuscarinic (oxybutynin/ tolterodine)
not responding to all other treatment: imipramine
Desmopressin
more potent and longer duration of action than vasopressin
no vasoconstrictor effects
side effects of desmopression
hyponatraemia
nausea
headache
