Nocturnal enuresis



Nocturnal enuresis

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Nocturnal enuresis


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Nocturnal enuresis

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USMLE® Step 1 style questions USMLE

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A 6-year-old boy is brought to the pediatrician by his parents due to recent bedwetting. He was toilet-trained at the age of 3 and has been able to stay dry during the day. However, he continues to have nighttime “accidents” 3-4 times per week. The patient consumes fluids in the morning and afternoon, but not prior to bed. The family recently moved from their home in the city to a suburban neighborhood, and he has experienced difficulty making new friends at school. Temperature is 37.2°C (99.0°F), blood pressure is 107/68 mmHg, and pulse is 79/min. A complete physical examination is noncontributory. The patient is subsequently trialed on scheduled timed voids overnight and a bedwetting alarm, both of which fail to control his symptoms. The patient is subsequently initiated on a medication that acts as an antidiuretic hormone analog. Which of the following medications was most likely prescribed?  

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Bedwetting p. 340

Nocturnal enuresis p. 340


Nocturnal enuresis or nighttime urinary incontinence is involuntary urination while asleep, after the age at which bladder control usually occurs, typically above 5 years old. Nocturnal enuresis is considered primary when a child has not yet had a prolonged period of being dry. Secondary nocturnal enuresis is when a child or adult begins wetting again after having stayed dry. The most common cause is a neurological-developmental delay. Other causes include low ADH levels, infections, and psychological issues.

Treatment for nocturnal enuresis may involve a combination of approaches, such as behavior modification techniques, medication, and lifestyle changes. Behavioral interventions may include setting a schedule for using the bathroom before bed, limiting fluid intake in the evening, and using an alarm to wake the child when they start to wet the bed. Medications such as desmopressin and imipramine may be used to help control bedwetting.


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