Improved efficiency of hypervolemic therapy with inhibition of natriuresis by fludrocortisone in patients with aneurysmal subarachnoid hemorrhage

Abstract

Intravascular volume expansion in the presence of excessive natriuresis requires a large sodium and water intake and is often associated with hyponatremia. Inhibition of natriuresis with fludrocortisone can effectively reduce the sodium and water intake required for hypervolemia and prevent hyponatremia at the same time.

Hyponatremia in the neurosurgical patient: diagnosis and management

“…20,72 Nevertheless, the findings of several studies contradict the idea that ANP is the primary factor behind CSW. For instance, ANP was found to decrease in the presence of experimental natriuresis induced by intracerebroventricular administration of hypertonic saline, 48 ANP was not elevated after SAH, 25,36 and normal levels of ANP were found in patients with CSW associated with intracerebral hemorrhage 73 and surgery for pituitary adenomas. 79 Brain natriuretic peptide is secreted by the cardiac ventricles in response to increased pressure or stretch, and displays biological effects similar to those of ANP; 30 furthermore, this substance has also been localized to the hypothalamus.…”

“…Abnormal serum levels of sodium are frequently observed during the acute period (4-10 days) 40,48,49,57,59,75 following aneurysmal SAH. 57 According to several reports, 29 to 43% of patients with SAH experience hyponatremia.…”

“…It is noteworthy that water replacement causes hyponatremia, and increased sodium intake does not prevent a negative sodium balance, but actually enhances urinary sodium excretion, natriuresis, and osmotic diuresis. 48,50 Aggressive hypervolemic therapies are not always effective on their own and some authors advocate the use of fludrocortisone or hydrocortisone, which inhibit natriuresis. 48,50 These agents function by promoting sodium resorption in the kidney through their mineralocorticoid effects.…”

“…48,50 Aggressive hypervolemic therapies are not always effective on their own and some authors advocate the use of fludrocortisone or hydrocortisone, which inhibit natriuresis. 48,50 These agents function by promoting sodium resorption in the kidney through their mineralocorticoid effects. 7 Mori and coworkers 48 found that fludrocortisone reduced the need for sodium replacement and water intake and decreased urine output and excretion of sodium.…”

“…48,50 These agents function by promoting sodium resorption in the kidney through their mineralocorticoid effects. 7 Mori and coworkers 48 found that fludrocortisone reduced the need for sodium replacement and water intake and decreased urine output and excretion of sodium. In a study by Moro, et al, 50 hydrocortisone therapy resulted in lower urine volumes, lower infusion volumes required for hypervolemic therapy, and higher central venous pressures.…”