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Vasopressin levels and pediatric head trauma
G Padilla1, J A Leake, R Castro
1Department of Pediatrics, University of California Los Angeles School of Medicine, Torrance 90509.
Insights
Pediatric head trauma patients showed increased urine vasopressin levels. Some developed syndrome of inappropriate antidiuretic hormone secretion, indicating a potential risk in these children.
Area of Science:
- Pediatric endocrinology
- Neurotrauma research
- Clinical diagnostics
Background:
- Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is linked to head trauma.
- Limited data exists on vasopressin levels in pediatric head trauma patients.
Purpose of the Study:
- To measure urine vasopressin levels in pediatric patients with head trauma.
- To investigate the association between vasopressin levels and SIADH development in this population.
Main Methods:
- Radioimmunoassay was used to measure urine vasopressin in 8 pediatric head trauma patients.
- Measurements included urine/serum electrolytes, osmolality, urea nitrogen, creatinine, and fluid intake.
- Data was collected within 24 hours of admission and for two subsequent days.
Main Results:
- Pediatric head trauma patients exhibited elevated mean urine vasopressin levels compared to healthy controls.
- 25% of head trauma patients developed SIADH despite fluid restriction.
- High urine osmolality (>800 mosm/kg) correlated with significantly increased urine vasopressin levels.
Conclusions:
- Elevated urine vasopressin is observed in pediatric patients following head trauma.
- High urine vasopressin levels may predict the risk of developing SIADH in pediatric head trauma cases.
- Further investigation is warranted for managing SIADH in pediatric head trauma.
Abstract:
The syndrome of inappropriate secretion of antidiuretic hormone is associated with head trauma; however, there are no reports concerning vasopressin levels in pediatric patients with head trauma. Urine vasopressin in eight children (mean +/- SEM, age 7.5 +/- 1.6 years, range 1 to 15 years) was measured by radioimmunoassay during their hospitalization for head trauma. Urine vasopressin values for ten healthy children (mean age 5.4 +/- 1.3 years) and for eight children hospitalized for systemic antibiotic treatment of infections (age 5.9 +/- 1.8 years) also were obtained. Urine vasopressin, urine and serum sodium concentration and osmolality, urea nitrogen, creatinine, and fluid intake were measured within 24 hours of admission and daily for the following two days. For the first three days following head trauma, mean urine vasopressin levels in pediatric patients with head trauma were increased (P less than .05) compared with those of healthy children. Despite fluid restriction to 85% of maintenance level, 25% of patients with head trauma exhibited the clinical syndrome of inappropriate secretion of antidiuretic hormone (hyponatremia, increased urinary sodium, diminished serum osmolality, and urine osmolality greater than serum osmolality). Urine osmolality greater than 800 mosm/kg was associated with markedly increased urine vasopressin levels (200 to 1,650 pg/mL); children with this finding may be at particular risk for the syndrome of inappropriate secretion of anti-diuretic hormone without restrictive water intake.