A randomized controlled trial of hydrocortisone against hyponatremia in patients with aneurysmal subarachnoid hemorrhage

Yoichi Katayama, Jo Haraoka, Hidehiro Hirabayashi, Tatsuro Kawamata, Keiji Kawamoto, Takao Kitahara, Jun Kojima, Toshihiko Kuroiwa, Tatsuro Mori, Nobuhiro Moro, Izumi Nagata, Akira Ogawa, Kikuo Ohno, Yoshikatsu Seiki, Yoshiaki Shiokawa, Akira Teramoto, Teiji Tominaga, Toshiki Yoshimine

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74 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - Hyponatremia is common after aneurysmal subarachnoid hemorrhage (SAH). It is caused by natriuresis, which induces osmotic diuresis and decreases blood volume, contributing to symptomatic cerebral vasospasm (SCV). Hypervolemic therapy to prevent SCV will not be efficient under this condition. We conducted a randomized controlled trial to assess the efficacy of hydrocortisone, which promotes sodium retention in the kidneys. METHODS - Seventy-one SAH patients were randomly assigned after surgery to treatment with either a placebo (n=36) or 1200 mg/d of hydrocortisone (n=35) for 10 days and tapered thereafter. Both groups underwent hypervolemic therapy. The primary end point was the prevention of hyponatremia. RESULTS - Hydrocortisone prevented excess sodium excretion (P=0.04) and urine volume (P=0.04). Hydrocortisone maintained the targeted serum sodium level throughout the 14 days (P<0.001), and achieved the management protocol with lower sodium and fluid (P=0.007) supplementation. Hydrocortisone kept the normal plasma osmolarity (P<0.001). SCV occurred in 9 patients (25%) in the placebo group and in 5 (14%) in the hydrocortisone group. No significant difference in the overall outcome was observed between the 2 groups. CONCLUSIONS - Hydrocortisone overcame excess natriuresis and prevented hyponatremia. Although there was no difference in outcome, hydrocortisone supported efficient hypervolemic therapy.

Original languageEnglish
Pages (from-to)2373-2375
Number of pages3
JournalStroke
Volume38
Issue number8
DOIs
Publication statusPublished - 2007 Aug

Keywords

  • Hydrocortisone
  • Hyponatremia
  • Multicenter studies
  • Randomized controlled trials
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

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