Orthostatic fluid-electrolyte and endocrine responses in fainters and nonfainters

A tilt-table test was administered to five young men before (test 1) and after (test 2) 8 days of heat acclimation (2-h daily exercise at 50% VO2max at 40 degrees db, 30 degrees C wb) and to five other young men before and after the same exercise at 24 degrees C to determine fluid-electrolyte and endocrine responses in orthostasis in fainters and nonfainters. Half of the 10 subjects showed improved orthostatic reactions from test 1 to test 2 (disappearance of nausea and dizziness and improved heart rate and blood pressure), and the other 5 subjects showed no improvement. The improvement, especially in the nonfainters, was related to increases in posttilt plasma volume (PV) and plasma concentration of potassium. During test 1, plasma renin activity (PRA) increased five times from supine to orthostatis, with a corresponding increase in plasma vasopressin (ADH) of 50 times. The corresponding increases in test 2 were lower by 50 and 75% compared with those occurring in test 1 for PRA and ADH, respectively. PRA was five times higher in nonfainters than in fainters in test 1, whereas ADH showed an opposite trend. The orthostatic-induced increase in ADH seems to be related to volume control independent of PRA. This increase is reduced with improvement in orthostatic reactions, probably because of an increase in PV.