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Clinical settings and vasopressin function in hyponatraemic children

  • Endocrinology
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Abstract

Hyponatraemia is one of the most common electrolyte abnormalities in hospitalised children. In a prospective study we tested whether hyponatraemia is associated with sustained release of the antidiuretic hormone arginine vasopressin (AVP). Out of 27 children with persistent hyponatremia (serum sodium <130 mmol/l), 25 had measurable plasma concentrations of AVP [median and quartiles 5.0 pg/ml (1.5–8.3)]. Volume contraction as consequence of sodium loss caused hyponatraemia in 16 patients. Hyponatraemia in the presence of extracellular volume expansion and reduced effective arterial blood volume occurred in 5 patients. Only 3 patients had normovolaemic hyponatraemia (so-called syndrome of inappropriate antidiuretic hormone secretion) and 3 suffered from chronic renal failure. It is concluded that plasma AVP concentration is measurable in most children with hyponatraemia. Non-osmotic stimulation of AVP release and lack of suppression of this hormone is an important pathogenetic mechanism of hyponatraemia in children.

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Abbreviations

AVP:

arginine vasopressin

SIADH:

Syndrome of inappropriate antidiuretic hormone secretion

References

  1. Anderson RJ, Chung HM, Kluge R, Schrier W. Hyponatremia (1985) A prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med 102: 164–168

    Google Scholar 

  2. Anderson RJ, Cadnapaphornchai P, Harbottle JA, McDonald KM, Schrier RW (1974) Mechanism of effect of thoracic inferior vena cava constriction on renal water excretion. J Clin Invest 54: 1473–1479

    Google Scholar 

  3. Bald M, Rascher W (1990) Determination and characterization of arginine-asopressin in extracted and unextracted urine and its urinary excretion in normal children and adolescents. Horm Res 34: 60–65

    Google Scholar 

  4. Berry PL, Belsha CW (1990) Hyponatremia. Pediatr Clin North Am 37: 351–363

    Google Scholar 

  5. Bichet D, Szatalowicz V, Chaimovitz C, Schrier RW (1982) Role of vasopressin in abnormal water excretion in cirrhotic patients. Ann Intern Med 96: 413–417

    Google Scholar 

  6. Bode U (1981) The antidiuresis following cyclophosphamide therapy is not due to inappropriate ADH secretion. In: Rayband C, Clement R, Lebreuil G, Bernard JL (eds) Pediatric oncology, International Congress Series No 570. Excerpta Medica, Amsterdam, pp 359–363

    Google Scholar 

  7. Chemtop S, Reece ER, Mills EL (1985) Syndrome of inappropriate secretion of antidiuretic hormone in enteroviral meningitis. Am J Dis Child 139: 292–294

    Google Scholar 

  8. Fine RN, Clarke RR, Shore NA (1966) Hyponatremia and vincristine therapy. Am J Dis Child 122: 256–259

    Google Scholar 

  9. Gozal D, Colin AA, Jaffe M, Hochberg Z (1990) Water, electrolyte, and endocrine homeostasis on infants with bronchiolitis. Pediatr Res 27: 204–209

    Google Scholar 

  10. Gross PA, Pehrisch H, Rascher W, Schömig A, Hackenthal E, Ritz E (1987) Pathogenesis of clinical hyponatremia: observation of vasopressin and fluid intake in 100 hyponatremic medical patients. Eur J Clin Invest 17: 123–129

    Google Scholar 

  11. Gross P, Ketteler M, Hausmann C, Reinhard C, Schömig A, Hackenthal E, Ritz E, Rascher W (1988) Role of diuretics, hormonal derangements, and clinical settings of hyponatremia in medical patients. Klin Wochenschr 66: 662–669

    Google Scholar 

  12. Gruskin AB, Baluarte HJ, Prebis JW, Polinsky MS, Morgenstern BZ, Perlman SA (1982) Serum sodium abnormalities in children. Pediatr Clin North Am 29: 907–932

    Google Scholar 

  13. Hazinski TA, Blalock WA, Englehardt B (1988) Control of water balance in infants with bronchopulmonary dysplasia: role of endogenous vasopressin. Pediatr Res 23: 86–88

    Google Scholar 

  14. Heijden AJVD, Versteegh FGA, Wolff ED, Sukkai RN, Scholtmeijer RJ (1985) Acute tubular dysfunction in infants with obstructive uropathy. Acta Paediatr Scand 74: 589–594

    Google Scholar 

  15. Judd BA, Haycock GB, Dalton N, Chantler C (1987) Hyponatremia in premature babies and following surgery in older children. Acta Paediatr Scand 76: 385–393

    Google Scholar 

  16. Judd BA, Haycock GB, Dalton RN, Chantler C (1990) Antidiuretic hormone following surgery in children. Acta Paediatr Scand 79: 461–466

    Google Scholar 

  17. Kaplan SL, Feigin RD (1978) The syndrome of inappropriate secretion of the antidiuretic hormone in children with bacterial meningitis. J Pediatr 92: 758–761

    Google Scholar 

  18. Kojima T, Fukuda Y, Hirata Y, Matsuzaki S, Kobayashi Y (1990) Changes in vasopressin, atrial natriuretic factor, and water homeostasis in the early stage of bronchopulmonary dysplasia. Pediatr Res 27: 260–263

    Google Scholar 

  19. Montani JP, Liard JF, Schoun J, Möhring J (1990) Hemodynamic effects of exogenous and endogenous vasopressin at low plasma concentration in conscious dogs. Circ Res 47: 346–355

    Google Scholar 

  20. Moses AM (1989) Osmotic thresholds for AVP release with the use of plasma and urine AVP and free water clearance. Am J Physiol 256: R892-R897

    Google Scholar 

  21. Padilla G, Ervin MG, Ross MG, Leake RD (1991) Vasopressin levels in infants during the course of aseptic and bacterial meningitis. Am J Dis Child 145: 991–993

    Google Scholar 

  22. Paxson CL, Stoerner JW, Denson SE, Adcock EW, Morris FH (1977) Syndrome of inappropriate antidiuretic hormone secretion in neonates with pneumothorax or atelectasis. J Pediatr 91: 459–463

    Google Scholar 

  23. Powell KR, Sugarman LI, Eskenazi AE, Woodin KA, Kays MA, McCormick KL, Miller ME, Sladek CD (1991) Normalization of plasma arginine vasopressin concentrations when children with meningitis are given maintenance plus replacement fluid therapy. J Pediatr 117: 515–522

    Google Scholar 

  24. Rao M, Eid N, Herrod L, Parekh A, Steiner P (1986) Antidiuretic hormone response in children with bronchopulmonary dysplasia during episodes of acute respiratory distress. Am J Dis Child 140: 825–828

    Google Scholar 

  25. Rascher W, Tulassay T (1987) Hormonal regulation of water metabolism in children with nephrotic syndrom. Kidney Intern 32 [Suppl 21]: S83-S89

    Google Scholar 

  26. Rascher W, Lang RE, Unger T, Ganten D, Gross F (1982) Vasopressin in brain of spontaneously hypertensive rats. Am J Physiol 242: H496-H499

    Google Scholar 

  27. Rascher W, Meffle H, Gross F (1985) Hemodynamic effects of arginine vasopressin in conscious water-deprived rats. Am J Physiol 249, H29-H33

    Google Scholar 

  28. Rascher W, Rauh W, Brandeis WE, Huber KH, Schärer K (1986) Determinants of plasma arginine vasopressin in children. Acta Paediatr Scand 75: 111–117

    Google Scholar 

  29. Rees L, Brook CGS, Shaw JCL, Forsling ML (1984) Hyponatremia in the first week of life in preterm infants. Part I, Arginine vasopressin secretion. Arch Dis Child 59: 412–422

    Google Scholar 

  30. Robertson GL, Bhoopalam N, Zelkowitz LJ (1973) Vincristine neurotoxicity and abnormal secretion of antidiuretic hormone. Arch Intern Med 132: 717–720

    Google Scholar 

  31. Rohm N, Erhard J, Rascher W, Eigler FW (1990) Traumatischer bilateral Nierenarterienverschluß. Chirurg 61: 541–544

    Google Scholar 

  32. Schrier RW (1988) Pathogenesis of sodium and water retention in high-output and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy. N Engl J Med 319: 1065–1072, 1127–1134

    Google Scholar 

  33. Schrier RW, Berl T, Anderson RJ (1979) Osmotic and nonosmotic control of vasopressin. Am J Physiol 236: F321-F332

    Google Scholar 

  34. Szatalowicz WL, Arnold RE, Chaimowitz C, Bichet D, Berl T, Schrier RW (1981) Radioimmunoassay of plasma arginine vasopressin in hyponatremic patients with congestive heart failure. N Engl J Med 305: 263–266

    Google Scholar 

  35. Tausch A, Stegner H, Leake RD, Artmann HG, Fisher DA (1983) Radioimmmuno-assay of arginine vasopressin in urine: development and application. J Clin Endocrinol Metab 57: 777–781

    Google Scholar 

  36. Weinberg JA, Weitzman RE, Zakauddin S, Leake RD (1977) Inappropriate secretion of antidiuretic hormone in a premature infant. J Pediatr 90: 111–114

    Google Scholar 

  37. Zerbe RL, Robertson GL (1983) Osmoregulation of thirst and vasopressin secretion in human subjects: effect of various solutes. Am J Physiol 244: E607-E614

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Essen (GHS), Hufelandstrasse 55, W-4300, Essen 1, Germany

    M. Gerigk, M. Bald, F. Feth & W. Rascher

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  1. M. Gerigk
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  2. M. Bald
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  3. F. Feth
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  4. W. Rascher
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Gerigk, M., Bald, M., Feth, F. et al. Clinical settings and vasopressin function in hyponatraemic children. Eur J Pediatr 152, 301–305 (1993). https://doi.org/10.1007/BF01956738

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  • DOI: https://doi.org/10.1007/BF01956738

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