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Idiopathic hypovolemia: a self-perpetuating autonomic dysfunction?

O Kuchel1, J Léveillé

  • 1Clinical Research Institute of Montreal, Hôtel-Dieu of Montreal Hospital and University of Montreal, Quebec, Canada.

Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society
|December 30, 1998
PubMed
Summary
This summary is machine-generated.

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Episodic hypertension and tachycardia in patients may stem from hypovolemia. Surges in dopamine sulfate, not other catecholamines, correlate with these episodes, suggesting a role in blood pressure dysregulation.

Area of Science:

  • Endocrinology
  • Cardiovascular Physiology
  • Neurochemistry

Background:

  • Patients present with unexplained episodic hypertension, hypotension, orthostatic intolerance, tachycardia, anxiety, and flushing.
  • Hypovolemia was investigated as a potential underlying cause for these symptoms.

Purpose of the Study:

  • To investigate the role of blood volume and plasma catecholamines in patients with unexplained episodic autonomic dysfunction.
  • To determine if dopamine sulfate plays a role in these episodes.

Main Methods:

  • Blood volume measured using Cr51-labeled hemoglobin.
  • Plasma catecholamines (norepinephrine, epinephrine, dopamine) and dopamine sulfate measured radioenzymatically.
  • Measurements taken at baseline, during upright posture, and during symptomatic episodes.

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Main Results:

  • Patients exhibited significant decreases in blood volume in recumbent and upright positions.
  • Baseline catecholamine levels and postural responses were largely normal, with one exception of hyperresponsive plasma renin activity.
  • During episodes, moderate increases in norepinephrine and epinephrine were observed, but not free dopamine.
  • A significant pathological increase in dopamine sulfate was noted during symptomatic episodes.

Conclusions:

  • Hypovolemia contributes to symptoms, with sympathetic arousal being inappropriately low for the degree of hypovolemia.
  • Episodic surges in dopamine sulfate, reflecting extraneuronal dopamine discharge, appear to outpace sympathetic responses.
  • The role of increased dopamine sulfate in perpetuating hypovolemia via natriuresis or aldosterone inhibition requires further investigation.