# Situation: A 27-year-old man has passed about 6 liters of urine a day for 2 months and is always thirsty, preferring ice-cold water. His serum sodium is 144 mEq/L (135–145), and his urine specific gravity is 1.002. He takes no medicines. He is admitted for a supervised water deprivation test. Three months later he uses desmopressin nasal spray. He calls because heavy urination and thirst have returned over 2 days. He has a head cold with a blocked nose, and he has not missed any doses. Which explanation is MOST likely?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630515  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 27-year-old man has passed about 6 liters of urine a day for 2 months and is always thirsty, preferring ice-cold water. His serum sodium is 144 mEq/L (135–145), and his urine specific gravity is 1.002. He takes no medicines. He is admitted for a supervised water deprivation test.

Three months later he uses desmopressin nasal spray. He calls because heavy urination and thirst have returned over 2 days. He has a head cold with a blocked nose, and he has not missed any doses. Which explanation is MOST likely?

## 보기

1. The cold has caused his body to make less vasopressin
2. Drinking extra fluids for the cold is diluting his urine
3. Nasal congestion is reducing absorption of the drug **✔ 정답**
4. His kidneys have stopped responding to the drug

**정답: 3**

## 해설

Intranasal desmopressin is absorbed through the nasal mucosa, and congestion or discharge reduces absorption, so under-dosing symptoms return. The nurse advises contacting the provider about an oral or other route until the congestion clears.

## 심화 해설

Why the nasal spray stopped working
Intranasal desmopressin is absorbed through the nasal mucosa. When the nose is congested or full of discharge, as with a head cold, the spray may not reach the absorbing surface, may run out of the nose, or may be swallowed. Less drug is absorbed, so his kidneys again receive too little antidiuretic effect, and polyuria and thirst return. A blocked nose reduces absorption of desmopressin nasal spray, causing under-dosing symptoms even when no doses are missed.

What the nurse advises
The nurse advises him to contact his provider about using an oral or other route until the congestion clears. Meanwhile, he should drink according to thirst so that he does not become dehydrated, monitor his weight and urine output, and seek care if he develops dizziness, confusion, or signs of significant dehydration. Once the cold resolves, absorption usually returns to normal, and he can resume the nasal spray if the provider agrees.

| Explanation | Likely? | Reason |
| --- | --- | --- |
| Cold reduced his own vasopressin | No | His production is already deficient |
| Extra fluids diluting urine | No | Would not cause heavy urination if the drug were absorbed |
| Nasal congestion reducing absorption | Yes | Blocked nose prevents mucosal absorption |
| Kidneys stopped responding | No | Resistance does not develop suddenly with a cold |

Why the other explanations are wrong
His own vasopressin production is already deficient, which is why he needs the drug, so a cold reducing it further would not explain a new change. Drinking extra fluids for a cold could increase urine slightly, but if the drug were being absorbed normally, his kidneys would still concentrate urine and he would not develop heavy urination with marked thirst. Sudden kidney resistance to vasopressin does not develop with a cold. Watch out! When a drug given by a specific route stops working, think first about whether the route is still delivering the drug.

Exam takeaway
Teaching for nasal desmopressin includes correct spray technique, the effect of colds, allergies, or nasal surgery on absorption, and when to call for a route change. Key point! Nasal congestion reduces absorption of desmopressin spray; the client should contact the provider about an alternative route.

## 임상 시나리오

Desmopressin Nasal Spray and ColdsReduced absorption with congestion
Intranasal desmopressin is absorbed through the nasal mucosa; congestion or discharge reduces absorption.

Under-dosing brings back polyuria and thirst, even without missed doses.

Advise contacting the provider about an oral or other route until the congestion clears; drink to thirst and monitor weight and urine output.

CautionSeek care for dizziness, confusion, or signs of dehydration while absorption is reduced.

## 핵심 개념

- **Intranasal route** — Drug delivery through the nasal mucosa, which depends on a clear, healthy nasal lining.
- **Nasal mucosa** — The moist lining of the nasal cavity through which nasal sprays are absorbed.
- **Polyuria** — Passage of abnormally large volumes of urine.

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