TY - JOUR
T1 - A randomized controlled trial of hydrocortisone against hyponatremia in patients with aneurysmal subarachnoid hemorrhage
AU - Katayama, Yoichi
AU - Haraoka, Jo
AU - Hirabayashi, Hidehiro
AU - Kawamata, Tatsuro
AU - Kawamoto, Keiji
AU - Kitahara, Takao
AU - Kojima, Jun
AU - Kuroiwa, Toshihiko
AU - Mori, Tatsuro
AU - Moro, Nobuhiro
AU - Nagata, Izumi
AU - Ogawa, Akira
AU - Ohno, Kikuo
AU - Seiki, Yoshikatsu
AU - Shiokawa, Yoshiaki
AU - Teramoto, Akira
AU - Tominaga, Teiji
AU - Yoshimine, Toshiki
PY - 2007/8
Y1 - 2007/8
N2 - BACKGROUND AND PURPOSE - Hyponatremia is common after aneurysmal subarachnoid hemorrhage (SAH). It is caused by natriuresis, which induces osmotic diuresis and decreases blood volume, contributing to symptomatic cerebral vasospasm (SCV). Hypervolemic therapy to prevent SCV will not be efficient under this condition. We conducted a randomized controlled trial to assess the efficacy of hydrocortisone, which promotes sodium retention in the kidneys. METHODS - Seventy-one SAH patients were randomly assigned after surgery to treatment with either a placebo (n=36) or 1200 mg/d of hydrocortisone (n=35) for 10 days and tapered thereafter. Both groups underwent hypervolemic therapy. The primary end point was the prevention of hyponatremia. RESULTS - Hydrocortisone prevented excess sodium excretion (P=0.04) and urine volume (P=0.04). Hydrocortisone maintained the targeted serum sodium level throughout the 14 days (P<0.001), and achieved the management protocol with lower sodium and fluid (P=0.007) supplementation. Hydrocortisone kept the normal plasma osmolarity (P<0.001). SCV occurred in 9 patients (25%) in the placebo group and in 5 (14%) in the hydrocortisone group. No significant difference in the overall outcome was observed between the 2 groups. CONCLUSIONS - Hydrocortisone overcame excess natriuresis and prevented hyponatremia. Although there was no difference in outcome, hydrocortisone supported efficient hypervolemic therapy.
AB - BACKGROUND AND PURPOSE - Hyponatremia is common after aneurysmal subarachnoid hemorrhage (SAH). It is caused by natriuresis, which induces osmotic diuresis and decreases blood volume, contributing to symptomatic cerebral vasospasm (SCV). Hypervolemic therapy to prevent SCV will not be efficient under this condition. We conducted a randomized controlled trial to assess the efficacy of hydrocortisone, which promotes sodium retention in the kidneys. METHODS - Seventy-one SAH patients were randomly assigned after surgery to treatment with either a placebo (n=36) or 1200 mg/d of hydrocortisone (n=35) for 10 days and tapered thereafter. Both groups underwent hypervolemic therapy. The primary end point was the prevention of hyponatremia. RESULTS - Hydrocortisone prevented excess sodium excretion (P=0.04) and urine volume (P=0.04). Hydrocortisone maintained the targeted serum sodium level throughout the 14 days (P<0.001), and achieved the management protocol with lower sodium and fluid (P=0.007) supplementation. Hydrocortisone kept the normal plasma osmolarity (P<0.001). SCV occurred in 9 patients (25%) in the placebo group and in 5 (14%) in the hydrocortisone group. No significant difference in the overall outcome was observed between the 2 groups. CONCLUSIONS - Hydrocortisone overcame excess natriuresis and prevented hyponatremia. Although there was no difference in outcome, hydrocortisone supported efficient hypervolemic therapy.
KW - Hydrocortisone
KW - Hyponatremia
KW - Multicenter studies
KW - Randomized controlled trials
KW - Subarachnoid hemorrhage
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UR - http://www.scopus.com/inward/citedby.url?scp=34548202216&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.106.480038
DO - 10.1161/STROKEAHA.106.480038
M3 - Article
C2 - 17585086
AN - SCOPUS:34548202216
SN - 0039-2499
VL - 38
SP - 2373
EP - 2375
JO - Stroke
JF - Stroke
IS - 8
ER -