Desmopressin is used for nocturnal enuresis because it is effective in reducing bedwetting in children. Which of the following is a prudent approach when starting therapy?

• A. Start with a low dose and titrate upward
• B. Start with a high dose immediately
• C. Desmopressin should not be used in children
• D. Use only as a rescue therapy for bedwetting

Answer: (A)

Starting with the lowest effective dose and gradually increasing if needed is prudent because desmopressin works by reducing nighttime urine production, and the main safety concern is hyponatremia from excessive fluid retention. Beginning at a small dose minimizes this risk while allowing you to gauge how well the child responds. Pair the dose with evening fluid restriction and monitor for any signs of water intoxication (headache, confusion, swelling). If the response is incomplete, increase the dose within recommended limits rather than jumping to a high amount, and reassess after a few weeks. Desmopressin is a valid option for children with nocturnal enuresis when used carefully, not only as rescue therapy.