pituitrin and Meningitis

Topics: Dehydration; Fluid Therapy; Glucose; Humans; Hyponatremia; Infections; Meningitis; Pediatrics; Sodium Chloride; Vasopressins

To determine trends in pharmacotherapy for neonatal hypotension in all infants and in extremely low birth weight (ELBW, birth weight 300-1000 g) infants.. We queried the Pediatric Health Information System database for all infants ≤28 days with a diagnosis code for hypotension that were discharged between January 2001 and December 2012. Patients were excluded if they had complex congenital heart disease or cardiac surgery, sepsis or meningitis, or had extracorporeal membrane oxygenation. We determined trends in pharmacotherapy for hypotension in all infants and ELBW infants, an especially vulnerable group.. A total of 8019 hypotensive infants met study criteria. The 2 most prescribed medications were dopamine (65.3%) and dobutamine (19.9%). For 1487 hypotensive ELBW infants, the 2 most prescribed medications were dopamine (83.4%) and hydrocortisone (33%). During the study period, the use of dobutamine decreased, and hydrocortisone and vasopressin use increased for all infants and for ELBW infants.. Treatment of neonatal hypotension varies widely between institutions and individual practitioners, and pharmacotherapy for neonatal hypotension has changed over the past decade. Although dopamine and dobutamine were the most frequently used agents, their use has declined and the uses of hydrocortisone and vasopressin have increased.

Topics: Blood Pressure; Dobutamine; Dopamine; Drug Therapy; Extracorporeal Membrane Oxygenation; Female; Humans; Hydrocortisone; Hypotension; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Meningitis; Pediatrics; Retrospective Studies; Tertiary Care Centers; Time Factors; Treatment Outcome; Vasopressins

We measured urine vasopressin (VP) once daily on days 1 through 3 in 18 patients hospitalized with meningitis. Urine VP values were 215 +/- 100, 116 +/- 44, and 69 +/- 23 pg/mL on days 1 through 3, respectively, for children with bacterial meningitis and 34 +/- 14, 20 +/- 4, and 15 +/- 4 pg/mL for those with aseptic meningitis. Urinary VP levels of infants with bacterial meningitis were significantly greater than those of healthy ambulatory subjects (n = 18) on all three study days; VP values of infants with bacterial meningitis were also greater than those of infants with aseptic meningitis on study days 2 and 3. The VP levels for the subjects with aseptic meningitis were significantly greater than those of the controls on day 1 only. None of the infants exhibited the clinical syndrome of inappropriate antidiuretic hormone secretion.

Topics: Bacterial Infections; Humans; Inappropriate ADH Syndrome; Infant; Meningitis; Meningitis, Aseptic; Osmolar Concentration; Risk Factors; Sodium; Time Factors; Vasopressins

Topics: Child; Fluid Therapy; Humans; Meningitis; Vasopressins

Topics: Administration, Intranasal; Adult; Anesthesia, Spinal; Diabetes Insipidus; Humans; Iatrogenic Disease; Meningitis; Urethra; Vasopressins

Plasma concentrations of arginine vasopressin were determined by radioimmunoassay in 13 normal children, 21 patients with febrile illnesses (not bacterial meningitis), and 17 patients with bacterial meningitis. The mean +/- 1 SD concentrations of AVP in the normal children and patients with various febrile illnesses were 0.7 +/- 0.6 and 1.0 +/- 1.2 muU/ml, respectively. The mean +/- 1 SD concentration of AVP in patients with bacterial meningitis was 3.3 +/- 2.3 muU/ml. The concentrations of AVP in the patients with bacterial meningitis were significantly greater (P less than 0.001) than those noted in the normal children or children with other febrile diseases.

Topics: Adolescent; Arginine Vasopressin; Child; Child, Preschool; Fever; Humans; Infant; Meningitis; Radioimmunoassay; Syndrome; Vasopressins

A prospective study of bacterial meningitis in children was initiated two years ago. Serum sodium concentrations below 135 MEQ/liter were noted on admission in 72 of 124 (58.1 %) of patients enrolled in the study protocol. Low initial serum sodium concentration and prolonged depression in serum sodium despite fluid restriction correlated significanly (P less than 0.001 to 0.01) with the presence of neurologic sequelae of the disease. Inappropriate secretion of antidiuretic hormone as the cause of these electrolyte changes could be inferred by indirect measurement of serum and urine solute and volume data and was specifically documented, in patients enrolled most recently, by specific radioimmunoassay of antidiuretic hormone.

Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Meningitis; Sodium; Vasopressins; Water-Electrolyte Imbalance

Schwartz-Bartter-syndrome as a consequence of severe cerebral alterations like bacterial and tuberculous meningitis, encephalitis, hydrocephalus and brain haemorrhage has been observed in 7 cases. Massive natriuresis is followed by marked hyponatremia and hypochloremia which may lead to an intracellular brain edema. Sodium administered even in high dosage is lost rapidly through the kidney, and does not normalize the serum level of sodium. The Schwartz-Bartter-syndrome is caused by inadequatly elevated ADH-secretion with consecutive water retention and an increase in plasma volume. Consecutively an increased excretion of sodium takes place causing a substantial loss of bound water. An analogous situation was seen in a child with neurohormonal diabetes insipidus after an overdosage of ADH, which resulted in a hypervolemia, marked hyponatremia and massive natriuresis. The increased excretion of sodium may be the result of reduced reabsorption of sodium in the proximal tubuli of the kidney, caused by a humeral natriuretic factor (the socalled "third factor"). In the serum of one of our patients an increased natriuretic activity could be shown; this is the first time in a child with Schwartz-Bartter-syndrome.

Topics: Blood Volume; Brain Diseases; Brain Edema; Cerebral Hemorrhage; Child; Chlorides; Encephalitis; Female; Humans; Hydrocephalus; Hyponatremia; Infant; Infant, Newborn; Male; Meningitis; Natriuresis; Osmolar Concentration; Syndrome; Tuberculosis, Meningeal; Vasopressins

The syndrome of inappropriate ADH secretion was diagnosed on the basis of the cardinal features described by Bartter and Schwartz in 3 patients: one neonate with bacterial meningitis and two children respectively under Vincristin and Cyclophosphamide treatment. Treatment with fluid restriction and infusions of hypertonic saline led to a slow excretion of the water excess and to the restoration of both the body fluid volume and serum sodium concentration. The urinary excretion of aldosterone was found to be in the normal range or slightly increased during the development of the syndrome and at the beginning of the therapy. In the phase of recovery there was decreased urinary aldosterone.

Topics: Aldosterone; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Metabolic Diseases; Syndrome; Vasopressins

Topics: Brain Abscess; Brain Injuries; Enterococcus faecalis; Follow-Up Studies; Humans; Male; Meningitis; Military Medicine; Postoperative Complications; Prospective Studies; Pulmonary Embolism; Staphylococcal Infections; Streptococcal Infections; Surgical Wound Dehiscence; Surgical Wound Infection; Transportation of Patients; United States; Vasopressins; Vietnam; Warfare; Wounds, Gunshot

Topics: Female; Humans; Meningitis; Middle Aged; Pseudomonas aeruginosa; Pseudomonas Infections; Vasopressins

Topics: Hormones, Ectopic; Humans; Hyponatremia; Infant, Newborn; Infant, Newborn, Diseases; Male; Meningitis; Natriuresis; Osmolar Concentration; Pituitary Gland, Posterior; Vasopressins; Water-Electrolyte Balance

Topics: Asphyxia Neonatorum; Humans; Hypertonic Solutions; Hyponatremia; Infant, Newborn; Male; Meningitis; Osmolar Concentration; Osmosis; Punctures; Sodium; Sodium Chloride; Urine; Vasopressins

Topics: Adrenocorticotropic Hormone; Blindness; Breast Neoplasms; Central Nervous System Diseases; Diabetes Insipidus; Fistula; Follow-Up Studies; Gold Isotopes; Humans; Hypophysectomy; Meningitis; Pituitary Irradiation; Sella Turcica; Vasopressins