Effect of fludrocortisone acetate in patients with subarachnoid hemorrhage.

Abstract

In this study with randomized controls, we administered fludrocortisone acetate to 46 of 91 patients with subarachnoid hemorrhage in an attempt to prevent excessive natriuresis and plasma volume depletion. Fludrocortisone significantly reduced the frequency of a negative sodium balance during the first 6 days (from 63% to 38%, p = 0.041). A negative sodium balance was significantly correlated with decreased plasma volume during both the first 6 days (p = 0.014) and during the entire 12-day study period (p = 0.004). Although fludrocortisone treatment tended to diminish the decrease in plasma volume, the difference was not significant (p = 0.188). More patients in the control group developed cerebral ischemia (31% vs. 22%) and, consequently, more control patients were treated with plasma volume expanders (24% vs. 15%), which may have masked the effects of fludrocortisone on plasma volume. Fludrocortisone therefore reduces natriuresis and remains of possible therapeutic benefit in the prevention of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

“…494 In several uncontrolled studies, the development of volume contraction was found to be ameliorated by the administration of large amounts of fluids (hypervolemic therapy). 493,495 Two randomized, controlled trials have been performed to evaluate the ability of fludrocortisone to correct hyponatremia and fluid balance. One found that it helped to correct the negative sodium balance but not volume contraction or hyponatremia, 495 and the other reported a reduced need for fluids and improved sodium levels with fludrocortisone.…”

“…493,495 Two randomized, controlled trials have been performed to evaluate the ability of fludrocortisone to correct hyponatremia and fluid balance. One found that it helped to correct the negative sodium balance but not volume contraction or hyponatremia, 495 and the other reported a reduced need for fluids and improved sodium levels with fludrocortisone. 496 One retrospective study has suggested that 3% saline is effective in correcting hyponatremia.…”

Randomized, Double-Blind Trial of the Effect of Fluid Composition on Electrolyte, Acid–Base, and Fluid Homeostasis in Patients Early After Subarachnoid Hemorrhage

“…Volume contraction has been linked to symptomatic vasospasm [18], and fluid restriction has been associated with an increased incidence of delayed ischemic deficits [16]. In several uncontrolled studies, the development of volume contraction was found to be ameliorated by the administration of large amounts of fluids [17,19]. In another study, however, only hyponatremia but not decreased circulating blood volume was prevented by administration of large amounts of sodium and water, adapted to renal excretion [20].…”

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

“…One trial found that it helped to correct the negative sodium balance, and the other reported a reduced need for fluids and improved sodium levels using this mineralocorticoid. 305,306 A similar randomized, placebo-controlled trial showed reduced natriuresis and a lower rate of hyponatremia in aSAH patients treated with hydrocortisone. 307 The value of albumin as an efficient volume expander during the vasospasm phase in aSAH has been suggested in uncontrolled studies, but there is no clear evidence of its superiority over crystalloids in patients with aSAH.…”