Association of aldosterone and arginine vasopressin concentrations and clinical markers of hypoperfusion in neonatal foals

Dembek, Katarzyna; Hurcombe, Samuel D.A.; Stewart, Allison J.; Barr, Bonnie S.; MacGillivray, K.; Kinee, M.; Elam, Justine; Toribio, Ramiro E.

doi:10.1111/evj.12393

Cited by 9 publications

(8 citation statements)

References 34 publications

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“…The increase in AVP may be due to lower pressures in the OH group compared with the syncope group at the time of the hormonal measurement, given that syncope occurred later in the HUT. A com-bination of high Aldo and AVP has also recently been associated with hospitalized neonatal foals with clinical hypoperfusion, providing further evidence for these clinical biomarkers to identify subjects with volume depletion and/or poor tissue perfusion (9). Considering that AVP release is most sensitive to reduced serum osmolality followed by sensitivity to decreases in BP, our findings are consistent with the reduction in effective BP and perfusion as the stimulus for release of this hormone.…”

Section: Discussionsupporting

confidence: 86%

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

Wagoner

Shaltout

Fortunato

et al. 2016

American Journal of Physiology-Heart and Circulatory Physiology

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Studies of adults with orthostatic intolerance (OI) have revealed altered neurohumoral responses to orthostasis, which provide mechanistic insights into the dysregulation of blood pressure control. Similar studies in children with OI providing a thorough neurohumoral profile are lacking. The objective of the present study was to determine the cardiovascular and neurohumoral profile in adolescent subjects presenting with OI. Subjects at 10-18 yr of age were prospectively recruited if they exhibited two or more traditional OI symptoms and were referred for head-up tilt (HUT) testing. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured in the supine position and after 15 min of 70° tilt. Heart rate and blood pressure were continuously measured. Of the 48 patients, 30 patients had an abnormal tilt. Subjects with an abnormal tilt had lower systolic, diastolic, and mean arterial blood pressures during tilt, significantly higher levels of vasopressin during HUT, and relatively higher catecholamines and ANG II during HUT than subjects with a normal tilt. Distinct neurohumoral profiles were observed when OI subjects were placed into the following groups defined by the hemodynamic response: postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), syncope, and POTS/syncope. Key characteristics included higher HUT-induced norepinephrine in POTS subjects, higher vasopressin in OH and syncope subjects, and higher supine and HUT aldosterone in OH subjects. In conclusion, children with OI and an abnormal response to tilt exhibit distinct neurohumoral profiles associated with the type of the hemodynamic response during orthostatic challenge. Elevated arginine vasopressin levels in syncope and OH groups are likely an exaggerated response to decreased blood flow not compensated by higher norepinephrine levels, as observed in POTS subjects. These different compensatory mechanisms support the role of measuring neurohumoral profiles toward the goal of selecting more focused and mechanistic-based treatment options for pediatric patients with OI.

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Section: Discussionsupporting

confidence: 86%

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

Wagoner

Shaltout

Fortunato

et al. 2016

American Journal of Physiology-Heart and Circulatory Physiology

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“…Of the 39 foals with hypernatraemia, 33 (84.6%) had evidence of clinical hypoperfusion as defined by Dembek et al, 13 with hyperlactaemia and a combination of tachycardia, haemoconcentration and/or azotaemia evident on clinical and laboratory evaluations. Of the 1115 foals with normonatraemia on ICU admission (admission serum sodium concentration 131-140 mmol/L), 535 (48%) had evidence of clinical hypoperfusion.…”

Section: Signalment and Clinical Findings Of Foals With Admission Hypmentioning

confidence: 94%

“…Foals were classified as febrile if their temperature at admission was > 38.8°C. Foals were classified as clinically hypoperfused if they had L‐lactate concentrations ≥ 2.5 mmol/L and one of the following three laboratory and clinical findings: heart rate > 120 beats/min, packed cell volume > 0.44 L/L or azotaemia defined as creatinine ≥ 221 μmol/L and/or blood urea nitrogen ≥ 9.64 mmol/L . Foals were classified as normoperfused if they had L‐lactate concentrations < 2.5 mmol/L or ≥ 2.5 mmol/L with no evidence of tachycardia, haemoconcentration or azotaemia …”

Section: Methodsmentioning

confidence: 99%

“…a < 2.5 mmol/L or ≥ 2.5 mmol/L with no evidence of tachycardia, haemoconcentration or azotaemia. 13 Outcome variables evaluated were short-term and long-term survival and were determined as previously described. 14 For foals that were euthanased, the reason for euthanasia was recorded when available (clinician-determined poor prognosis or financial reasons) and those that were euthanased for financial reasons alone were excluded from statistical analysis of mortality rate.…”

Section: Case Selectionmentioning

confidence: 99%

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Hypernatraemia in 39 hospitalised foals: clinical findings, primary diagnosis and outcome

Collins¹,

Carrick²,

Russell³

et al. 2018

Aust Veterinary J

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Objective To evaluate hypernatraemia in foals presenting as medical emergencies to an intensive care unit (ICU) to determine the prevalence, clinical findings, primary diagnosis and outcome. Methods Retrospective case study of records from Thoroughbred foals aged less than 3 months that presented to an ICU as medical emergencies in 2002–12. Data retrieved included signalment, clinical findings, laboratory results, primary diagnosis and outcome. Foals with hypernatraemia (serum sodium > 145 mmol/L) on admission laboratory data were identified and further evaluated. Results A total of 39 of 1718 foals (2.3%) were diagnosed with hypernatraemia; all foals were less than 7 days of age. The most common primary diagnoses in the foals with hypernatraemia were neonatal syndrome (19/39, 48.7%) and sepsis (15/39, 38.5%). Foals with hypernatraemia at presentation were more likely to die or be euthanased during their hospitalisation than foals with a normal serum sodium concentration on ICU admission (33.3% vs 16.1%; odds ratio, 2.3; 95% confidence interval, 1.2–4.6; P = 0.02). Conclusion Admission hypernatraemia was an uncommon but important electrolyte abnormality in this population of hospitalised foals. Although the short‐term outcome in survivors was most likely dependent on the underlying disease process, hypernatraemia was negatively associated with outcome in hospitalised foals.

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“…The use and the clinical benefits of vasopressin in adult horses during CPR have not been determined (Muir and Hubbel 2009). The benefit of vasopressin is discussed controversial (Valverde et al 2006, Hurcombe et al 2008, Dembek et al 2014. Some authors even do not mention vasopressin when listing vasopressors (Holcombe 2006).…”

Section: Introductionmentioning

confidence: 99%

Vasopressin is life threatening for horses under isoflurane anaesthesia

Wollanke¹,

Reimold²,

Gerhards³

2015

PHK

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Summary: The aim of the study was to examine the effects of vasopressin on the cardiovascular system of horses under isoflurane anaesthesia. For this purpose ten horses of various breeds were taken which had to be euthanized under general anaesthesia. Decision for euthanasia was made either during surgery or during radiographic examination due to diagnosis of a fatal condition. The horses consisted of 7 geldings, 2 mares, and 1 male foal, aged 14±8,5 (mean±SD) years and weighing 499,5±105,1 (mean±SD) kg. Before euthanasia was performed during general anaesthesia, vasopressin was administered. Five horses obtained an intravenous injection of 0,2IU vasopressin/kg and five horses were given an infusion of 0,08IU vasopressin/kg minute over a 10 minute period. Mean arterial blood pressure, heart rate, colour of mucous membranes, capillary refill time, ocular reflexes, ECG, and respiratory frequency and volume were determined. Furthermore, arterial blood gas analysis, capnography and pulse oximetry were performed. Additionally, cardiac ultrasound and heart auscultation were conducted in four horses. The results were that the blood pressure increased within 30-60 seconds of vasopressin administration and that all horses developed a high degree of ischemia of the mucous membranes during the 30-60 seconds after either vasopressin injection or vasopressin infusion. Eight horses died due to cardiac failure. Cardiac arrest occurred in four horses within 5 minutes of vasopressin injection as well as in four horses during the 10 minutes of vasopressin infusion. In four horses an ultrasound examination during vasopressin administration revealed acute cardio dilation causing cardiac arrest. It can be concluded that Vasopressin is fatal for horses under general anaesthesia. The use of vasopressin must be avoided in horses. Vasopressin must not be used as an alternative drug for adrenaline in horses.Keywords: Vasopressin / horse / isoflurane anaesthesia / cardiac dilation / cardiac arrest / lethal / anesthesiology Citation: Wollanke B., Reimold R., Gerhards H. (2015) Vasopressin is life threatening for horses under isoflurane anaesthesia. Pferdeheilkunde 31, 341-345

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Association of aldosterone and arginine vasopressin concentrations and clinical markers of hypoperfusion in neonatal foals

Abstract: Hyperaldosteronaemia and hypervasopressinaemia as well as hypothermic extremities and increased albumin concentrations are potent predictors of hypoperfusion in hospitalised foals.

Cited by 9 publications

References 34 publications

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

Hypernatraemia in 39 hospitalised foals: clinical findings, primary diagnosis and outcome

Vasopressin is life threatening for horses under isoflurane anaesthesia

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