This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Simma, B. Articles by Fanconi, S. Search for Related Content PubMed PubMed Citation Articles by Simma, B. Articles by Fanconi, S. Related Collections Neuroanesthesia Pediatrics

---

PEDIATRIC ANESTHESIA

The Release of Antidiuretic Hormone Is Appropriate in Response to Hypovolemia and/or Sodium Administration in Children with Severe Head Injury: A Trial of Lactated Ringer’s Solution Versus Hypertonic Saline

Burkhard Simma, MD^*§, René Burger, MD^*, Markus Falk, MSC^||, Peter Sacher, MD, Timo Torresani, PhD, and Sergio Fanconi, MD^*

*Intensive Care Unit, Department of Pediatric Surgery, and Department of Pediatrics, Children’s Hospital, Zurich, Switzerland; §Intensive Care Unit, Children’s Hospital, Innsbruck, Austria; and ||Institute of Medical Statistics and Epidemiology, Munich, Federal Republic of Germany

Address correspondence and reprint requests to Burkhard Simma, MD, Children’s Hospital, 6800 Feldkirch, Austria. Address e-mail to burkhard.simma{at}lkhf.at

We conducted an open, randomized, and prospective study to determine the effect of hypertonic saline on the secretion of antidiuretic hormone (ADH) and aldosterone in children with severe head injury (Glasgow coma scale <8). Thirty-one consecutive patients at a level III pediatric intensive care unit at a children’s hospital received either lactated Ringer’s solution (Ringer’s group, n = 16) or hypertonic saline (Hypertonic Saline group, n = 15) over a 3-day period. Serum ADH levels were significantly larger in the Hypertonic Saline group as compared with the Ringer’s group (P = 0.001; analysis of variance) and were correlated to sodium intake (Ringer’s group: r = 0.39, R² = 0.15, P = 0.02; Hypertonic Saline group: r = 0.42, R² = 0.18, P = 0.02) and volume of fluids given IV (Ringer’s group: r = 0.38, R² = 0.15, P = 0.02; Hypertonic Saline group: r = 0.32, R² = 0.1, P = not significant). Correlation of ADH to plasma osmolality was significant if plasma osmolality was >280 mOsm/kg (r = 0.5, R² = 0.25, P = 0.06), indicating an osmotic threshold for ADH release. Serum aldosterone levels were larger on the first day than during Days 2 and 3 in both groups and inversely correlated to serum sodium levels only in the Ringer’s group (r = -0.55, R² = 0.3, P < 0.001). This group received a significantly larger fluid volume on Day 1 (P = 0.05, Mann-Whitney U-test) than did patients in the Hypertonic Saline group, indicating hypovolemia during the first day. Head-injured children have appropriate levels of ADH. They may be hypovolemic during the first day of treatment, especially if they receive lactated Ringer’s solution.

Implications: In head-injured patients, we recommend fluid restriction to avoid inappropriate secretion of antidiuretic hormone. In a prospective, randomized, and controlled study in 31 children, we were able to show that the antidiuretic hormone levels are appropriate in response to hypovolemia, sodium load, or both.