pituitrin and Craniocerebral-Trauma

According to scientific publications focusing on emergency medicine and published in international journals in the past few months, new and clinically important results can be identified. In patients with severe head trauma (SHT), application of hypertonic solutions is possible; long term outcome, however, is not improved by this measure. Prehospital capnometry is important, because otherwise up to 40 % of all mechanically ventilated patients are hypoventilated. In a study in 200 patients with prehospital cardiac arrest and ventricular fibrillation as initial cardiac rhythm, subgroup analysis (alarm-response time > 5 min) showed an increase in survival rate (14 % vs. 2 %), if defibrillation was proceeded by 3 min of conventional cardiopulmonary resuscitation (CPR) for reperfusion. If ACD ("active compression decompression")-CPR is combined with a specific ventilatory valve ("inspiratory impedance threshold device", ITD) which does not allow passive inspiration, survival rate after cardiac arrest is increased for up to 24 h. Such a device facilitates an increase in venous return to the heart during decompression of the thorax. High-dose adrenalin for intrahospital CPR in children is not associated with better survival but with worse outcome. Comparison of an emergency medical service (EMS) system from U.K. with paramedics and a physician-staffed German EMS system demonstrated that survival rate following prehospital cardiac arrest is markedly increased with doctors on board. The European multicentre trial comparing vasopressin vs. adrenalin as first vasopressor during CPR in 1219 patients did not reveal any differences between both groups. In subgroup analyses of patients with asystoly and prolonged CPR, vasopressin was superior without being associated with a benefit on neurological outcome. Further subgroup analyses revealed beneficial effects of amiodarone and thrombolysis during CPR. Thrombolysis during CPR apears to be associated with an increased rate of haemodynamic stabilisation without increased risk of bleeding complications. In a very clear advisory statement, the "International Liaison Committee on Resuscitation" (ILCOR) has recommended mild therapeutic hypothermia (i. e., cooling of cardiac arrest victims to 32 - 34 degrees C central body temperature for 12 - 24 h following cardiac arrest of cardiac etiology) not only for unconciuous patients with ventricular fibrillation as initial prehospital rhythm, but also for all other adult patients (ot

Topics: Cardiopulmonary Resuscitation; Craniocerebral Trauma; Electric Countershock; Emergency Medicine; Epinephrine; Heart Arrest; Humans; Hypertonic Solutions; Hypothermia, Induced; Multiple Trauma; Prognosis; Respiration, Artificial; Thrombolytic Therapy; Vasoconstrictor Agents; Vasopressins

Topics: Blood Volume; Child; Craniocerebral Trauma; Deamino Arginine Vasopressin; Dehydration; Diabetes Mellitus, Type 1; Diuresis; Female; Humans; Kinetics; Male; Models, Biological; Neurophysins; Osmolar Concentration; Oxytocin; Pituitary Gland, Posterior; Postoperative Complications; Pregnancy; Pregnancy in Diabetics; Thirst; Urine; Vasopressins

Topics: Accidents, Traffic; Acidosis; Acute Kidney Injury; Adult; Aged; Alkalosis; Aortic Diseases; Aortic Rupture; Body Composition; Calorimetry; Cholecystectomy; Convalescence; Craniocerebral Trauma; Dehydration; Duodenal Ulcer; Endocrine Glands; Female; Homeostasis; Humans; Iliac Artery; Infusions, Parenteral; Kidney; Lung Neoplasms; Male; Metabolism; Middle Aged; Natriuresis; Pancreatitis; Peptic Ulcer Perforation; Postoperative Care; Postoperative Complications; Thoracic Injuries; Thrombosis; Vasopressins; Water-Electrolyte Balance

We conducted an open, randomized, and prospective study to determine the effect of hypertonic saline on the secretion of antidiuretic hormone (ADH) and aldosterone in children with severe head injury (Glasgow coma scale <8). Thirty-one consecutive patients at a level III pediatric intensive care unit at a children's hospital received either lactated Ringer's solution (Ringer's group, n = 16) or hypertonic saline (Hypertonic Saline group, n = 15) over a 3-day period. Serum ADH levels were significantly larger in the Hypertonic Saline group as compared with the Ringer's group (P = 0.001; analysis of variance) and were correlated to sodium intake (Ringer's group: r = 0.39, R(2) = 0.15, P = 0.02; Hypertonic Saline group: r = 0.42, R(2) = 0.18, P = 0.02) and volume of fluids given IV (Ringer's group: r = 0.38, R(2) = 0.15, P = 0.02; Hypertonic Saline group: r = 0.32, R(2) = 0.1, P = not significant). Correlation of ADH to plasma osmolality was significant if plasma osmolality was >280 mOsm/kg (r = 0.5, R(2) = 0.25, P = 0.06), indicating an osmotic threshold for ADH release. Serum aldosterone levels were larger on the first day than during Days 2 and 3 in both groups and inversely correlated to serum sodium levels only in the Ringer's group (r = -0.55, R(2) = 0.3, P < 0.001). This group received a significantly larger fluid volume on Day 1 (P = 0.05, Mann-Whitney U-test) than did patients in the Hypertonic Saline group, indicating hypovolemia during the first day. Head-injured children have appropriate levels of ADH. They may be hypovolemic during the first day of treatment, especially if they receive lactated Ringer's solution.. In head-injured patients, we recommend fluid restriction to avoid inappropriate secretion of antidiuretic hormone. In a prospective, randomized, and controlled study in 31 children, we were able to show that the antidiuretic hormone levels are appropriate in response to hypovolemia, sodium load, or both.

Topics: Adolescent; Aldosterone; Child; Child, Preschool; Craniocerebral Trauma; Humans; Hypovolemia; Infant; Isotonic Solutions; Prospective Studies; Ringer's Lactate; Saline Solution, Hypertonic; Sodium; Vasopressins

Topics: Administration, Intranasal; Adolescent; Adult; Craniocerebral Trauma; Female; Humans; Injury Severity Score; Lypressin; Male; Memory Disorders; Middle Aged; Neuropsychological Tests; Pilot Projects; Retrospective Studies; Vasopressins

Topics: Adult; Clinical Trials as Topic; Craniocerebral Trauma; Female; Humans; Male; Mental Disorders; Neurologic Examination; Vasopressins

Topics: Carbutamide; Chlorpropamide; Clinical Trials as Topic; Clopamide; Craniocerebral Trauma; Diabetes Complications; Diabetes Insipidus; Diuresis; Furosemide; Glomerular Filtration Rate; Humans; Male; Middle Aged; Vasopressins

Topics: 17-Hydroxycorticosteroids; Acromegaly; Adenoma, Chromophobe; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Brain Diseases; Central Nervous System Diseases; Clinical Trials as Topic; Craniocerebral Trauma; Diabetes Insipidus; Female; Humans; Hypothalamo-Hypophyseal System; Intracranial Pressure; Male; Metyrapone; Pituitary Diseases; Pituitary Function Tests; Pituitary Neoplasms; Pseudotumor Cerebri; Vasopressins

To explore pathological mechanisms of central hyponatremia and its treatment.. Synchronous assay was made for changes of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), endogenous digitalis-like substance (EDLS), antidiuretic hormone (ADH) in blood, and Na(+) concentrations in blood and urine, and plasma- and urine-osmolality in 68 patients with acute craniocerebral injury (ACI).. Of the 68 patients with ACI, 27 were found to have hyponatremia, and such illness was mostly concentrated on severe cases.. The central hyponatremia in patients with ACI may be related to the increase in the secretion of EDLS and ADH as the result of damaged functions of the hypothalamic-hypophysial system, and it seems that the decrease in blood ANP and BNP has no direct effect on Na(+) concentrations in blood. Inappropriate secretion of antidiuretic hormone syndrome and cerebral salt-wasting syndrome are the two main reasons for hyponatremia in patients with craniocerebral injury. The pathological mechanism, diagnostic standards, as well as treatment methods for the two, however, are not just the same. Intravenous injection of extrinsic thyrotropin-releasing hormone might inhibit dilutional hyponatremia arising from the increase in ADH secretion by patients with ACI.

Topics: Adolescent; Adult; Atrial Natriuretic Factor; Cardenolides; Case-Control Studies; Child; Child, Preschool; Craniocerebral Trauma; Female; Glasgow Coma Scale; Humans; Hyponatremia; Hypothalamo-Hypophyseal System; Male; Middle Aged; Natriuretic Peptide, Brain; Neurophysins; Protein Precursors; Saponins; Vasopressins; Young Adult

Traumatic hypopituitarism was diagnosed in an 11-month-old male neutered cat. The presenting complaints were polydipsia, polyuria and lethargy of three months' duration. Craniocerebral trauma, as a result of a road traffic accident, had preceded the onset of clinical signs by six weeks. Neurological examination revealed right-sided mydriasis, reduced visual and tactile left forelimb placing reflexes and decreased proprioception in both the left fore- and hindlimb. Initial laboratory findings included hypernatraemia, hyperchloraemia, mild azotaemia, eosinophilia and isosthenuria. Low basal cortisol, thyroxine, thyroid-stimulating hormone and insulin growth factor-1 were noted. Subsequent to treatment with prednisolone, a water deprivation test confirmed the presence of central diabetes insipidus and therapy with synthetic antidiuretic hormone successfully ameliorated the polydipsia.

Topics: Accidents, Traffic; Adrenal Insufficiency; Animals; Cat Diseases; Cats; Craniocerebral Trauma; Diabetes Insipidus; Diagnosis, Differential; Male; Vasopressins

Hyponatremia is commonly seen in patients with severe and moderate head injury, but it is rarely reported in those with mild head injury. The authors report a patient with mild head injury who presented with data typical of inappropriate secretion of antidiuretic hormone (SIADH), but showed no clinical deterioration. Though the clinical significance of this condition is unclear, the true incidence of this pathology might well be found to be higher than expected, should it receive more clinical and/or serological attention. Continuing clinical assessment will be needed to determine the significance of this condition in relation to that in patients with SIADH following the various causes reported previously.

Topics: Aged; Craniocerebral Trauma; Female; Humans; Hyponatremia; Syndrome; Vasopressins

The effect of therapy for hyponatremia with central origin (cerebrovascular disease and head injury) was investigated in order to examine contributing factors. Out of a total of 58 subjects admitted to the hospital during the previous three years with cerebrovascular disease (49 cases), and head injuries (9 cases), hyponatremia with central origin occurred within 2 weeks. Special treatment for hyponatremia was not given in 30 of the 58 cases (control group). The group (28 cases) which underwent therapy was optionally selected in terms of the following-SIADH, natriuretic polypeptide involvement and sick cells resulting from Na-K pump disorder. These 28 cases were classified into subgroups: water restricted (7 cases), hypertonic NaCl load (9 cases), glucose/insulin/potassium (GIK) therapy (4 cases), phenytoin administration (8 cases). In all of the 58 patients, the serum sodium, potassium and osmolarity and urinary sodium and potassium were measured daily. The balance of water, sodium and potassium were calculated on hyponatremic phase. Plasma levels of such hormones as antidiuretic hormone, aldosterone and cortisol were measured on hyponatremic phase. For each group, onset day and duration of hyponatremia and lowest sodium value were investigated for the sake of comparison. No significant difference for onset day and lowest sodium value was found between each group. Duration was as follows: control group 9.4 +/- 3.3 days, water restricted 7.4 +/- 2.1 days, hypertonic NaCl load 3.3 +/- 1.4 days, GIK therapy 7.3 +/- 2.9 days and phenytoin administration 8.9 +/- 3.7 days. Hypertonic NaCl load indicated a significantly shorter duration compared with the other groups. Hypertonic NaCl load was found to be most effective for hyponatremia with central origin.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aldosterone; Cerebrovascular Disorders; Craniocerebral Trauma; Glucose; Humans; Hydrocortisone; Hyponatremia; Inappropriate ADH Syndrome; Insulin; Phenytoin; Potassium; Saline Solution, Hypertonic; Sodium; Vasopressins; Water-Electrolyte Balance

The syndrome of inappropriate secretion of antidiuretic hormone is associated with head trauma; however, there are no reports concerning vasopressin levels in pediatric patients with head trauma. Urine vasopressin in eight children (mean +/- SEM, age 7.5 +/- 1.6 years, range 1 to 15 years) was measured by radioimmunoassay during their hospitalization for head trauma. Urine vasopressin values for ten healthy children (mean age 5.4 +/- 1.3 years) and for eight children hospitalized for systemic antibiotic treatment of infections (age 5.9 +/- 1.8 years) also were obtained. Urine vasopressin, urine and serum sodium concentration and osmolality, urea nitrogen, creatinine, and fluid intake were measured within 24 hours of admission and daily for the following two days. For the first three days following head trauma, mean urine vasopressin levels in pediatric patients with head trauma were increased (P less than .05) compared with those of healthy children. Despite fluid restriction to 85% of maintenance level, 25% of patients with head trauma exhibited the clinical syndrome of inappropriate secretion of antidiuretic hormone (hyponatremia, increased urinary sodium, diminished serum osmolality, and urine osmolality greater than serum osmolality). Urine osmolality greater than 800 mosm/kg was associated with markedly increased urine vasopressin levels (200 to 1,650 pg/mL); children with this finding may be at particular risk for the syndrome of inappropriate secretion of anti-diuretic hormone without restrictive water intake.

Topics: Adolescent; Child; Child, Preschool; Craniocerebral Trauma; Humans; Hyponatremia; Inappropriate ADH Syndrome; Infant; Osmolar Concentration; Sodium; Vasopressins

We examined the relation between plasma atrial natriuretic peptide (ANP) and the changes of the regulating hormones ADH and renin aldosterone in 20 neurosurgical intensive care patients. All patients suffered from elevated intracranial pressure due to severe head trauma or severe subarachnoidal hemorrhage of the anterior circulation. Under controlled mechanical hyperventilation (CMV) with PEEP, 15 patients without evidence of central dysregulation showed no change in plasma ANP, ADH and aldosterone. In five patients with severe central dysregulation of either electrolytes or blood pressure, increases of plasma ANP of various degrees could be observed together with a decline in serum aldosterone.

Topics: Aldosterone; Atrial Natriuretic Factor; Brain Diseases; Craniocerebral Trauma; Critical Care; Humans; Intracranial Pressure; Reference Values; Renin; Subarachnoid Hemorrhage; Vasopressins; Water-Electrolyte Balance

Severe hyponatremia developed within 2 weeks of head injuries in three elderly patients. Before the head injuries occurred, normal serum levels of sodium had been found in two of the three patients. Hyponatremia (105 to 117 meq/L) was associated with persistently increased urinary excretion of sodium. The patients appeared dehydrated and had lost weight. The mean plasma level of antidiuretic hormone was 5.0 +/- 1.6 (SD) pg/mL, which was relatively high despite decreased osmolality. Plasma renin activity was suppressed to 0.25 +/- 0.13 ng/mL X h, and plasma aldosterone levels measured low-normal or normal. Plasma renin activity and plasma aldosterone levels remained unchanged after the patients were given furosemide and placed in an upright position. The hyponatremia promptly resolved after the administration of fludrocortisone acetate, 0.1 to 0.4 mg/d. These observations indicate that severe hyponatremia occurs in elderly persons rapidly after head injuries, that it responds well to mineralocorticoid hormone therapy, and that both central nervous system and renal components may be involved in the mechanisms of action of the disorder.

Topics: Aged; Aged, 80 and over; Craniocerebral Trauma; Female; Fludrocortisone; Humans; Hyponatremia; Male; Natriuresis; Renin-Angiotensin System; Vasopressins

Topics: Chlorothiazide; Chlorpropamide; Craniocerebral Trauma; Diabetes Insipidus; Dopamine; Humans; Vasopressins

Permanent diabetes insipidus following head trauma is uncommon, but potentially fatal. The neurologic, roentgenographic, and endocrinologic findings in ten patients with this condition are reported. Eight of the patients were males under the age of 35 years. Unconsciousness (nine) and skull fracture (seven) were frequent findings. Cranial nerve damage (four) and anterior pituitary hormone deficiency requiring replacement (one) were less frequent. An automobile accident caused the trauma in six patients. Standard water deprivation tests revealed that five of the patients had total deficiency of antidiuretic hormone (ADH), and the other five had partial deficiency. The diagnosis of diabetes insipidus was markedly simplified by using a new screening test based on comparing urine and plasma osmolality in candidates with those of normal subjects.

Topics: Adult; Craniocerebral Trauma; Diabetes Insipidus; Female; Humans; Male; Osmolar Concentration; Polyuria; Vasopressins

Three patients with head injury are described to illustrate certain features of the development, treatment and recovery of hyponatraemia. The hyponatraemia is initially due to water retention but true sodium depletion may develop because of an associated urine sodium loss. The mechanism of the latter is discussed.

Topics: Adult; Craniocerebral Trauma; Extracellular Space; Female; Humans; Hyponatremia; Male; Sodium; Urea; Vasopressins

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

A patient is presented with diabetes insipidus secondary to craniofacial trauma. Diabetes insipidus can occur in any patient within ten days of craniofacial trauma. Even the masked disease in the unconscious patient can be diagnosed by observation of intake and output, urinary specific gravities, and appropriate chemical studies. The disease can recur following operative reduction of facial fractures. Diabetes insipidus can be successfully treated by intramuscular Pitressin and appropriate fluid intake.

Topics: Accidents, Traffic; Adolescent; Craniocerebral Trauma; Diabetes Insipidus; Facial Injuries; Humans; Male; Vasopressins

Topics: Acute Disease; Adult; Ataxia; Barbiturates; Consciousness Disorders; Craniocerebral Trauma; Electroencephalography; Epilepsy; Female; Humans; Hyponatremia; Nystagmus, Pathologic; Porphobilinogen; Porphyrias; Urinary Incontinence; Vasopressins; Water-Electrolyte Balance

Topics: Adrenocorticotropic Hormone; Aldosterone; Catecholamines; Craniocerebral Trauma; Dehydration; Electrolytes; Glucagon; Glucose; Growth Hormone; Humans; Hydrocortisone; Hypernatremia; Hyponatremia; Metabolic Diseases; Vasopressins; Water Intoxication; Water-Electrolyte Balance

Topics: Animal Nutritional Physiological Phenomena; Animals; Blood; Blood Glucose; Body Water; Body Weight; Chlorides; Craniocerebral Trauma; Hematocrit; Hypothalamus; Male; Osmolar Concentration; Pituitary Gland; Pituitary Gland, Posterior; Potassium; Rats; Sodium; Time Factors; Vasopressins

Topics: Carcinoma, Bronchogenic; Craniocerebral Trauma; Diuresis; Drinking; Extracellular Space; Humans; Hypertonic Solutions; Hyponatremia; Lung Neoplasms; Methods; Nicotine; Osmolar Concentration; Pituitary Function Tests; Porphyrias; Sodium Chloride; Vasopressins

Topics: Carcinoma, Bronchogenic; Craniocerebral Trauma; Humans; Lung Neoplasms; Vasopressins

Topics: Adult; Clomiphene; Craniocerebral Trauma; Endocrine System Diseases; Estrogens, Conjugated (USP); Humans; Hyperaldosteronism; Hypoglycemia; Hypopituitarism; Insulin; Laurence-Moon Syndrome; Luteinizing Hormone; Male; Puberty, Precocious; Radioimmunoassay; Turner Syndrome; Vasopressins

Topics: Adult; Craniocerebral Trauma; Epilepsy, Tonic-Clonic; Hematoma, Subdural; Humans; Hyponatremia; Male; Middle Aged; Osmolar Concentration; Vasopressins

Topics: Blood Urea Nitrogen; Blood Volume; Craniocerebral Trauma; Hematocrit; Hodgkin Disease; Humans; Hypernatremia; Hyperpituitarism; Hyponatremia; Hypothyroidism; Male; Middle Aged; Renin; Sodium; Suicide; Vasopressins; Water-Electrolyte Balance

Topics: Brain; Brain Edema; Craniocerebral Trauma; Craniotomy; Humans; Hyponatremia; Natriuresis; Nutrition Disorders; Osmolar Concentration; Pituitary Gland; Postoperative Complications; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Contusions; Craniocerebral Trauma; Electrocardiography; Endocrine System Diseases; Humans; Male; Middle Aged; Vasopressins

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Craniocerebral Trauma; Diabetes Insipidus; Female; Glioma; Hodgkin Disease; Humans; Hypothalamo-Hypophyseal System; Male; Metyrapone; Middle Aged; Neurotransmitter Agents; Pinealoma; Pituitary Gland; Pituitary-Adrenal Function Tests; Skull Neoplasms; Vasopressins; Water-Electrolyte Balance

Topics: Blood Urea Nitrogen; Craniocerebral Trauma; Hematocrit; Humans; Hyperkalemia; Hypernatremia; Hypokalemia; Hyponatremia; Natriuresis; Osmosis; Potassium; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Adult; Bendroflumethiazide; Craniocerebral Trauma; Diabetes Insipidus; Diuresis; Humans; Hyponatremia; Kidney; Male; Vasopressins

Topics: Adrenocorticotropic Hormone; Adult; Aged; Angiography; Brain Edema; Cerebrovascular Disorders; Craniocerebral Trauma; Echoencephalography; Electroencephalography; Electrooculography; Female; Humans; Male; Middle Aged; Oxytocin; Perfusion; Vasopressins; Water-Electrolyte Balance

Topics: Craniocerebral Trauma; Diagnosis; Endocrine System Diseases; Humans; Hyponatremia; Inappropriate ADH Syndrome; Pathology; Urine; Vasopressins; Water-Electrolyte Balance

Topics: Aldosterone; Blood Volume; Bodily Secretions; Body Fluids; Craniocerebral Trauma; Creatine; Creatinine; Extracellular Space; Fluids and Secretions; Humans; Hyponatremia; Natriuresis; Physiology; Skull Fractures; Urine; Vasopressins

Topics: Brain; Brain Injuries; Craniocerebral Trauma; Diabetes Insipidus; Diabetes Insipidus, Neurogenic; Humans; Vasopressins