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Pathogenesis of Hyponatremia Observed in the Treatment of Acute Subarachnoid Hemorrhage Yasutaka Kurokawa 1 , Teiji Uede 1 , Osamu Honda 1 , Takaaki Kato 1 1Department of Neurosurgery, Kushiro City General Hospital Keyword: ADH , atrial natriuretic peptide , hyponatremia , SIADH , subarachnoid hemorrhage pp.905-911
Published Date 1992/10/1
DOI https://doi.org/10.11477/mf.1406900391
  • Abstract
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The cause of hyponatremia following subarach-noid hemorrhage (SAH) has been understood as aninappropriate secretion of antidiuretic hormone (SIADH). Whereas, water restriction for the man-agement of this condition sometimes induces a severe dehydration, resulting in vasospasm.

To clarify the pathogenesis of hyponatremia fol-lowing SAH, we measured the daily sodium and water balance with the plasma concentration of atrial natriuretic peptide (ANP), antidiuretic hor-mone (ADH), and plasma renin activity (PRA) in seventeen cases after subarachnoid hemorrhage.

Although the patients received an adequate amount of fluid (more than 4080ml/day ; daily average in seventeen cases) and sodium (more than 277 mEq/day; daily average in seventeen cases), eight out of the seventeen cases showed transient hyponatremia of a slight degree beginning on 8.8 days after SAH. ANP values were elevated marked-ly in fifteen out of the seventeen cases, remaining high during the first two weeks following SAH. ADH values were elevated remarkably in eight out of the seventeen cases. However, these values de-clined immediately to a normal range within two days following SAH. PRA were increased or came within the normal range, suggesting the lack of water retention.

Overall sodium balance and water balance did not differ significantly between hyponatremia cases and normonatremia ones, whereas, sodium balance in acute phase was significantly negative, associated with marked natriuresis in patients with hyponatremia. These correlations suggested that hyponatremia after SAH is the result of natriuresis by an increased ANP rather than ADH.

In conclusion, a greater replenishment of water and sodium is required to avoid hyponatremia with dehydration. This technique may be helpful for the prevention of vasospasms following SAH.


Copyright © 1992, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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