Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients

Arquivos de Neuro-Psiquiatria

Eliane De Araújo Cintra²  Jayme Antunes Maciel Jr²  Sebastião Araújo¹  Margaret De Castro¹  Edna Freitas Martins¹  Antônio Luiz Eiras Falcão¹  Luiz A.c. Sardinha¹  Renato G.g. Terzi¹  Desanka Dragosavac¹  Ana Paula Devite Cardoso¹  Rosmari A.r.a. Oliveira¹ 

[1] ,State University of Campinas Faculty of Medical Sciences Department of Neurology

关键词: brain lesion;    brain death;    vasopressin;    lesão cerebral;    morte encefálica;    vasopressina;   

DOI  :  10.1590/S0004-282X2004000200007

来源: SciELO

【 摘 要 】

INTRODUCTION: Patients with severe brain lesions (SBL) and brain-dead patients (BD) frequently present with vasopressin (AVP) secretion disorders. OBJECTIVE: To evaluate AVP serum levels in SBL and BD patients. DESIGN: Prospective, open label, observational trial. SETTING: A general teaching hospital. METHOD: Three groups of adult subjects (age> 18y) of both sexes were included in this study: control group: 29 healthy volunteers; SBL group: 17 patients with Glasgow Coma Scale (GCS)< 8; and BD group: 11 brain-dead patients. Samples of venous blood were collected in the morning at rest from healthy volunteers and at 8 hourly intervals over a period of 24h from SBL and BD patients for AVP determinations. Concomitantly, some clinical and laboratorial variables were also recorded. RESULTS: AVP serum levels (pg/ml) were [mean (SD); median]: control [2.2(1.1); 2.0]; SBL [5.7(6.3); 2.9]; and BD [2.6(1.0); 2.8]. AVP serum levels varied greatly in SBL patients, but without statistically significant difference in relation to the other groups (p=0.06). Hypotension (p=0.02), hypernatremia (p=0.0001), serum hyperosmolarity (p=0.0001) and urinary hypoosmolarity (p=0.003) were outstanding in BD patients when compared with SBL. CONCLUSIONS: The AVP serum levels did not demonstrate significant statistical difference between the groups, only showing a greater variability in SBL patients (manifested as serum spike levels). Hypernatremia and hyperosmolarity were present in BD patients, indicating a failure of the hypothalamic-pituitary system in AVP production and release.

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