Parvez Sajjad Sagar
BANGLADESH

Many deaths occurred in our country due to Dengue hemorrhagic fever/shock syndrome. I think one drug may be expedient in the management of Dengue hemorrhagic fever/shock syndrome. The name of the drug is Anti-diuretic hormone or Vasopressin.

In dengue fever, severe hyponatremia (Loss of sodium) is observed. If we block the loss of sodium, it may be helpful to the patient. In dengue fever, hyponatremia leads to encephalopathy. That is why the patient cannot survive. Anti-diuretic hormone is the drug which prevents loss of sodium i.e. it reabsorbs sodium. I give below some theoretical reference in support of my contention.

1. Aldosterone (anti- diuretic hormone) causes increase reabsorption of sodium and chloride ion & increase potassium ion excretion about 3,000 times that of hydrocortisone.
Ref -Principles of Medicinal Chemistry (4th edition William O. Foye; Thomas L. Lemke; David A. Williams).

2. Vasopressin is the most potent vasoconstrictor. Desmopressin acetate (synthetic vasopressin peptide) is sometimes used to treat Factor VIII bleeding disorders and to increase Factor VIII levels. The vasoconstrictor & bowel spastic actions have special usefulness in arresting hemorrhage from peptic ulcers.
Ref-- The Science and Practice of Pharmacy (19th edition); Remington.

3. (a)Thrombin activates Factor VIII and it also acts directly on platelets to cause them to aggregate and release their granules containing multiple other pro-coagulant factors.

3. (b)Vasopressin constricts the peripheral arteries and veins & also greatly increases water retention by the kidneys causes a person to recover from moderate degrees of shock.
Ref - Guyton: Textbook of Medical Physiology (8th edition)

4. (a)Activation of V-2 receptors by desmopressin or vasopressin increases circulating levels of pro-coagulating Factor VIII and von Willebrand factor. Presumably, vasopressin stimulates the secretion of von Willebrand factor and Factor VIII from storage sites in vascular endothelium.

4. (b)Vasopressin is stored in platelets and V-1receptors mediate platelet aggregation.

4. (c)In patients with renal insufficiency, desmopressin shortens bleeding time and increases circulating level of Factor VIII coagulant activity, Factor VIII related antigen and ristocetin cofactor; it also induces the appearance of von Willebrand factor multimers.
Ref - Goodman & Gilman's: The Pharmacological Basis of Therapeutics (9th edition; International edition)

Last updated: 1-08-2004 Vol 1 Issue 5 Art # 18

Sagar PS. ANTI-DIURETIC HORMONE (ADH) - ITS USE IN DENGUE-HEMORRHAGIC FEVER (DHF). Pediatric Oncall [serial online] 2004 [cited 2004 August 1];1. Art # 18. Available from:
http://www.pediatriconcall.com/fordoctor/viewersChoice/adh.asp