Antidiuretic hormone response to volume depletion in diabetic patients with cardiac autonomic dysfunction

Abstract

Thirty-three insulin-dependent diabetic patients were separated into two groups from the results of three different tests for cardiac vagal neuropathy: heart rate response to deep breathing, Valsalva manoeuvre and heart rate response to postural change. Seventeen patients were considered as without ('intact' patients) and 16 as with ('denervated' patients) cardiac autonomic dysfunction. One patient with a transplanted heart was also studied. Plasma antidiuretic hormone (ADH), plasma aldosterone and plasma renin activity (PRA) were measured immediately before and 60 min after intravenous administration of frusemide and passage from lying to standing. The kinetics of hormonal responses were analysed more precisely (five blood collections) in six patients of each group who were studied again. Heart rate and blood pressure were recorded before each blood collection. Volume depletion estimated from the rise in plasma protein (+ 11.9 and + 12.2% in 'denervated' and 'intact' patients respectively) and heart rate response (+ 1.06 and + 14.7%) were similar in both groups. Mean blood pressure was unchanged in the 'intact' patients whereas it fell in the 'denervated' patients (-13.5%). PRA (+ 161.5 and + 231.2% in 'denervated' and 'intact' patients respectively) and plasma aldosterone (+ 318.2 and 279%) increased in both groups whereas plasma ADH was stimulated only in 'intact' patients (+ 55.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Natriuretic Peptide in Diabetic Patients with Microangiopathy

“…Each of these groups included seven subjects. All patients were tested for cardiac parasympathetic neuropathy using three non-invasive indices (deep breathing, Valsalva maneuver and lying to standing maneuver) as described in a previous study (Grimaldi, Pruszczynski, Thervet and Ardaillou 1985). There were more patients with vagal dysautonomia in group II (5) than in group I (2).…”

Changes in Plasma Vasopressin Levels and Cardiovascular Function due to Postural Changes in Diabetic Neuropathy.

“…Therefore, the possibility is not ruled out that the neurons from the medulla oblongata to the hypothalamus might be impaired in diabetic and non-diabetic neuropathies. Grimaldi et al (1985) and Reid et al (1989) reported that plasma AVP failed to increase in response to decreases in blood pressure, despite increases in heart rate in diabetic neuropathy with cardiac autonomic dysfunction.…”

“…Moreover, the AVP response to volume depletion has been reported to be attenuated in diabetic patients with cardiac dysfunction (Grimaldi et al 1985). On the other hand, it is shown that AVP plays an essential role in the prevention of orthostatic hypotension in diabetic autonomic insufficiency (Saad et al 1988; Zanella et al 1992).…”