demeclocycline and Craniocerebral-Trauma

To clarify the characteristics of vasopressin (AVP) secretion in patients with the syndrome of inappropriate antidiuresis (SIAD) related to central nervous system disorders, we examined the response of AVP secretion to osmotic stimulus by hypertonic saline infusion and analyzed the possible causative factors in six patients with SIAD associated with head trauma or cerebral infarction. Hyponatremia developed after head trauma in four patients and cerebral infarction in two patients. In all patients the clinical state and laboratory findings fulfilled the criteria for SIAD, which was supported by either nonsuppressible plasma AVP levels or effectiveness of treatments with water restriction, demeclocycline, nonpeptide V2 AVP antagonist or diphenylhydantoin. Although patterns of plasma AVP response to the osmotic stimulus varied, plasma AVP concentrations neither increased nor decreased to undetectable levels with a rise in plasma osmolality. In one patient, plasma AVP levels responded to increasing plasma osmolality when plasma osmolality normalized; in which the threshold and the sensitivity of osmostat were normal. In two other patients, AVP secretion responded to plasma osmolality after the treatment. The changes in AVP secretion were not due to nonosmotic stimuli for AVP release. In conclusion, this study shows that patients with SIAD and central nervous system disorders may have persistent AVP secretion with a loss of hypotonic suppression such as found in patients with adrenal insufficiency or depletional hyponatremia in central nervous system disorders, indicating that careful evaluation is necessary to determine the relationship between persistent AVP secretion and the pathogenesis of hyponatremic disorders.

Topics: Aged; Arginine Vasopressin; Cerebral Infarction; Craniocerebral Trauma; Demeclocycline; Female; Follow-Up Studies; Hormone Antagonists; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Phenytoin; Saline Solution, Hypertonic; Water Deprivation; Water-Electrolyte Balance

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a common cause of hyponatremia. In this study a case of SIADH caused by head trauma is reported, in which severe hyponatraemia, escorted by life-threatening neurological symptoms was observed that could only be managed by parenteral sodium chloride infusions. Severe hyponatraemia was accompanied by elevated urinary sodium excretion, a characteristic sign of SIADH. After introducing the therapy with demeclocycline, a tetracycline type antibiotic that inhibits the renal action of antidiuretic hormone, serum sodium levels began to rise gradually, and the urinary sodium excretion slowly decreased. These observations show the effectiveness of demeclocycline in the treatment of SIADH.

Topics: Craniocerebral Trauma; Demeclocycline; Female; Humans; Inappropriate ADH Syndrome; Middle Aged

Two new observations of ISADH following head injury are described. A review of the medical literature is presented. Reports of ISADH after head injury are rare in comparison to the frequent occurrence of hydroelectrolytic disorders in the same situation. Attention is drawn to misleading clinical pictures, suggestive of neurosurgical conditions. Intracranial hematoma is frequently associated with ISADH and should be looked for in patients who fail to respond to therapy.

Topics: Aged; Craniocerebral Trauma; Demeclocycline; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male

The physiologic factors involved in vaseopressin (ADH) release and action are reviewed with emphasis on the interaction between osmotic and volume stimuli to the discharge of ADH. Abnormalities in reception of stimuli to ADH release, and in the impaired synthesis and release of ADH, are reviewed in relation to the causes of diabetes insipidus, and information on the biochemical changes which have been described in patients with nephrogenic diabetes insipidus is also discussed. We summarize the pathologic lesions and associated diseases found in 54 of our patients with diabetes insipidus. Criteria for establishing the diagnosis of diabetes insipdus are reviewed with emphasis on the dehydration test, including the importance of measuring plasma osmolality at the conclusion of water deprivation. Treatment of diabetes insipidus is briefly discussed with emphasis on the use of DDAVP and oral agents. The syndrome of inappropriate ADH secretion (SIADH) is reviewed including our experience with 39 patients. The differential diagnosis of SIADH, including the value of water loading and the measurement of ADH levels, is discussed. We comment on treatment of these patients including the use of investigational drugs. Lastly, we review the pharmacologic features and clinical relevance of some drugs which alter the release and action of ADH.

Topics: Analgesics; Animals; Antidepressive Agents, Tricyclic; Antineoplastic Agents; Brain; Brain Neoplasms; Carbamazepine; Craniocerebral Trauma; Demeclocycline; Diabetes Insipidus; Diuresis; Diuretics; Humans; Lithium; Osmolar Concentration; Pituitary Gland, Posterior; Sodium Chloride; Sulfonamides; Sulfonylurea Compounds; Vasopressins