A Randomized Controlled Trial of Hydrocortisone Against Hyponatremia in Patients With Aneurysmal Subarachnoid Hemorrhage

Katayama, Yoichi; Haraoka, Jo; Hirabayashi, Hidehiro; Kawamata, Tatsuro; Kawamoto, Keiji; Kitahara, Takao; Kojima, Jun; Kuroiwa, Toshihiko; Mori, Tatsuro; Moro, Nobuhiro; Nagata, Izumi; Ohno, Kikuo; Seiki, Yoshikatsu; Shiokawa, Yoshiaki; Teramoto, Akira; Tominaga, Teiji; Yoshimine, Toshiki

doi:10.1161/strokeaha.106.480038

Cited by 95 publications

(60 citation statements)

References 7 publications

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“…It seems therefore unlikely that the administration of corticosteroids to 11 vs. 6 patients in the saline versus balanced group has influenced our results. Nevertheless, it has been demonstrated that corticosteroids can influence water and sodium balance after subarachnoidal hemorrhage [26,27]. Fluid balance was not associated with arterial hypertension or the use of steroids or norepinephrine.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2012

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Background Hyper-and hyponatremia are frequently observed in patients after subarachnoidal hemorrhage, and are potentially related to worse outcome. We hypothesized that the fluid regimen in these patients is associated with distinct changes in serum electrolytes, acid-base disturbances, and fluid balance. Methods Thirty-six consecutive patients with SAH were randomized double-blinded to either normal saline and hydroxyethyl starch dissolved in normal saline (Voluven Ò ; saline) or balanced crystalloid and colloid solutions (Ringerfundin Ò and Tetraspan Ò ; balanced, n = 18, each) for 48 h. Laboratory samples and fluid balance were evaluated at baseline and at 24 and 48 h. Results Age [57 ± 13 years (mean ± SD; saline) vs. Conclusions Treatment with saline-based fluids resulted in a greater number of patients with hyperchloremia, hyperosmolality, and positive fluid balance >1,500 mL early after SAH, while administration of balanced solutions did not cause more frequent hyponatremia or hypo-osmolality. These results should be confirmed in larger studies.

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Section: Discussionmentioning

confidence: 97%

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

et al. 2012

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“…Hydrocortisone has been shown to promote sodium retention in the kidney. Katayama and colleagues 37 randomly assigned 71 patients with subarachnoid hemorrhage to placebo or 1200 mg/d of hydrocortisone for 10 days. The primary outcome in this study was the prevention of hyponatremia.…”

Section: E284mentioning

confidence: 99%

Management of hyponatremia

Lee

Kilonzo

Nistico

et al. 2013

CMAJ

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H yponatremia, defined as a decrease in serum sodium below 136 mmol/L, is a common occurrence in both inpatients and outpatients and can be found in up to 15% of the general hospital populations.1,2 Acute hyponatremia (duration < 48 h) and its management can be a cause of major morbidity and mortality among patients in hospital.3 Chronic hyponatremia (duration > 48 h), which is typically seen among older (≥ 65 yr) outpatients, also contributes to morbidity because it is often unrecognized.3,4 Typically, correction of serum sodium concentration in patients with acute hyponatremia should occur at a more rapid rate than in patients with chronic hyponatremia because the symptoms are usually more severe when serum sodium rapidly decreases over a short period. 1It is essential to determine the underlying cause of hyponatremia because the type of hyponatremia dictates the approach to therapy. Once the type is determined, clinicians need to weigh the evidence to determine what treatment will be the most effective. This can prove confusing and challenging for both primary care physicians and specialists because there are a myriad of treatment-related reviews and publications with no clear guide as to what the best evidence suggests for the treatment of hyponatremia in each setting.In this review, we discuss the evidence for the management of hyponatremia. A variety of management approaches (both pharmacologic and nonpharmacologic) exist in clinical practice. We set out to review the evidence from randomized controlled trials (RCTs) for strategies to treat hyponatremia. Not surprisingly, most RCT-level evidence comes from industry-sponsored trials of newer pharmacologic agents. 5,6 Our review was performed systematically; our methods are described in Box 1. After completing the review, it became clear that to provide the reader with a clinical ap proach that could be applied in practice, we also needed to review and discuss management strategies that are well established in practice but are not supported by RCT-level evidence. The clinical application of our results is shown in Box 2. How does the type of hyponatremia affect treatment?Although there are many approaches to the management of hyponatremia, one of the most common approaches used by nonexpert clinicians begins with an assessment of extracellular fluid (ECF) volume status. Because diabetes mellitus is becoming more prevalent in the adult population, clinicians should be mindful of ruling out hyperosmolar hyponatremia caused by hyperglycemia as a potential cause of hyponatremia. The clinical history and physical examination provide important diagnostic clues that help to classify the cause of hyponatremia as hypovolemic, euvolemic or hypervolemic. Hypovolemic hyponatremiaHypovolemic hyponatremia occurs in cases of volume contraction, such as is seen with vomiting and diarrhea, excessive sweating and use of diuretics.1 A patient may present with frank hypotension or with postural hypotension or tachycardia. In this setting, release of both antidiuretic hormone (...

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“…15,16,18 Among these complications, delayed cerebral ischemia (DCI) remains an important cause of morbidity and death. 15 Many studies have investigated the prevention or treatment of DCI after SAH.…”

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confidence: 99%

A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage

Obata

Takeda

Sato

et al. 2016

JNS

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S ubarachnoid hemorrhage (SAH) from a ruptured aneurysm is accompanied by several complications, including electrolyte abnormalities, vasospasm, hydrocephalus, cardiac dysfunction, and pulmonary edema. 15,16,18 Among these complications, delayed cerebral ischemia (DCI) remains an important cause of morbidity and death. 15 Many studies have investigated the prevention or treatment of DCI after SAH.Triple-H therapy (i.e., hypertension, hypervolemia, and hemodilution) has reportedly been an effective approach abbreviatioNs CI = cardiac index; CRP = C-reactive protein; DCI = delayed cerebral ischemia; ELWI = extravascular lung water index; GEDI = global end-diastolic volume index; PVPI = pulmonary vascular permeability index; SAH = subarachnoid hemorrhage; SVRI = systemic vascular resistance index; WFNS = World Federation of Neurosurgical Societies. obJective Subarachnoid hemorrhage (SAH) is often accompanied by pulmonary complications, which may lead to poor outcomes and death. This study investigated the incidence and cause of pulmonary edema in patients with SAH by using hemodynamic monitoring with PiCCO-plus pulse contour analysis. methods A total of 204 patients with SAH were included in a multicenter prospective cohort study to investigate hemodynamic changes after surgical clipping or coil embolization of ruptured cerebral aneurysms by using a PiCCO-plus device. Changes in various hemodynamic parameters after SAH were analyzed statistically. results Fifty-two patients (25.5%) developed pulmonary edema. Patients with pulmonary edema (PE group) were significantly older than those without pulmonary edema (non-PE group) (p = 0.017). The mean extravascular lung water index was significantly higher in the PE group than in the non-PE group throughout the study period. The pulmonary vascular permeability index (PVPI) was significantly higher in the PE group than in the non-PE group on Day 6 (p = 0.029) and Day 10 (p = 0.011). The cardiac index of the PE group was significantly decreased biphasically on Days 2 and 10 compared with that of the non-PE group. In the early phase (Days 1-5 after SAH), the daily water balance of the PE group was slightly positive. In the delayed phase (Days 6-14 after SAH), the serum C-reactive protein level and the global end-diastolic volume index were significantly higher in the PE group than in the non-PE group, whereas the PVPI tended to be higher in the PE group. coNclusioNs Pulmonary edema that occurs in the early and delayed phases after SAH is caused by cardiac failure and inflammatory (i.e., noncardiogenic) conditions, respectively. Measurement of the extravascular lung water index, cardiac index, and PVPI by PiCCO-plus monitoring is useful for identifying pulmonary edema in patients with SAH.Clinical trial registration no.: UMIN000003794 (clinicaltrials.gov)http://thejns.org/doi/abs/10.3171/2015.6.JNS1519

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A Randomized Controlled Trial of Hydrocortisone Against Hyponatremia in Patients With Aneurysmal Subarachnoid Hemorrhage

Cited by 95 publications

References 7 publications

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

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

Management of hyponatremia

A multicenter prospective cohort study of volume management after subarachnoid hemorrhage: circulatory characteristics of pulmonary edema after subarachnoid hemorrhage

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