caa a22 4500 477108180 CHVBK 20180405111601.0 cr unu---uuuuu 170330e19960801xx s 000 0 eng 10.1007/BF01411284 doi (NATIONALLICENCE)springer-10.1007/BF01411284 Rapid natriuresis and preventive hypervolaemia for symptomatic vasospasm after subarachnoid haemorrhage [Elektronische Daten] [K. Okuchi, M. Fujioka, A. Fujikawa, A. Nishimura, T. Konobu, S. Miyamoto, T. Sakaki] Summary: To prevent symptomatic cerebral vasospasm, we have used hypervolaemia (HV) or volume expansion in patients with aneurysmal subarachnoid haemorrhage (SAH) in recent years. In these patients we could not perform effective fluid and sodium (Na) replacement because of rapid and overwhelming water and Na loss. Although this phenomenon is characteristic under hypervolaemic states, we regard it important to elucidate the mechanism underlying initiation of vasospasm after aneurysmal SAH. Patients with aneurysmal SAH, operated on within 24 hours of onset, were analysed prospectively. We selected 17 patients in good pre-operative condition. Intravascular volume expansion was accomplished with plasma fractionate or albumin and crystalloid solutions in all patients. We divided the 17 patients into two groups; symptomatic spasm group (S-group) consisting of 4 cases developing transient ischaemic symptoms and non-symptomatic spasm group (NS-group) consisting of 13 cases. In S-group, rapid and marked natriuresis developed characteristically before the onset of ischaemic symptoms. The differences in daily Na balance between the two groups were significant on the 3rd and 5th days (p < 0.05). The mean cumulative Na balance in S-group during the 10 days of the study (−375 ± 159 mEg) was higher than that of NS-group (−24.4 ± 225 mEq) (p < 0.05). Rapid natriuresis preceded the development of ischaemic symptoms, and was important as a trigger for symptomatic vasospasm after SAH. We considered that hormonal disorders were implicated in this phenomenon, and atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), renin, and aldosterone were each measured three times during the period, with no significant differences, found between the two groups. It was speculated that another potent natriuretic factor, similar to ANP, induced a rapid selective natriuresis resulting in symptomatic vasospasm. Springer-Verlag, 1996 Cerebral vasospasm nationallicence hypervolaemia nationallicence natriuresis nationallicence atrial natriuretic peptide nationallicence Okuchi K. Department of Neurosurgery, Nara Medical University, Shijo-cho, Kashihara, Japan aut Fujioka M. Department of Neurosurgery, Nara Medical University, Shijo-cho, Kashihara, Japan aut Fujikawa A. Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, Kashihara, Japan aut Nishimura A. Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, Kashihara, Japan aut Konobu T. Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, Kashihara, Japan aut Miyamoto S. Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, Kashihara, Japan aut Sakaki T. Department of Neurosurgery, Nara Medical University, Shijo-cho, Kashihara, Japan aut Acta Neurochirurgica Springer-Verlag 138/8(1996-08-01), 951-957 0001-6268 138:8<951 1996 138 701 https://doi.org/10.1007/BF01411284 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF01411284 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Okuchi K. Department of Neurosurgery, Nara Medical University, Shijo-cho, Kashihara, Japan aut NATIONALLICENCE 700 1- Fujioka M. Department of Neurosurgery, Nara Medical University, Shijo-cho, Kashihara, Japan aut NATIONALLICENCE 700 1- Fujikawa A. Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, Kashihara, Japan aut NATIONALLICENCE 700 1- Nishimura A. Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, Kashihara, Japan aut NATIONALLICENCE 700 1- Konobu T. Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, Kashihara, Japan aut NATIONALLICENCE 700 1- Miyamoto S. Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, Kashihara, Japan aut NATIONALLICENCE 700 1- Sakaki T. Department of Neurosurgery, Nara Medical University, Shijo-cho, Kashihara, Japan aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer-Verlag 138/8(1996-08-01), 951-957 0001-6268 138:8<951 1996 138 701 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer