Raised intracranial pressure, the syndrome of inappropriate antidiuretic hormone secretion, and arginine vasopressin in tuberculous meningitis.
Intracranial pressure (ICP) monitored shortly after admission over a period of 1 h in 31 children with tuberculous meningitis (TBM) was significantly higher (median 22.5 mmHg, range 8.4-50.9 mmHg) in 19 children with laboratory evidence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) than in 12 children without such evidence (median 16.2 mmHg, range 5.8-42.5 mmHg; P = 0.027). Neither plasma nor cerebrospinal fluid arginine vasopressin (AVP) was related to ICP (r = 0.33 and 0.13 respectively). Mean arterial pressure (MAP) was measured in 23 children and a moderate correlation was found with plasma AVP (r = 0.62; P = 0.0019). In TBM, plasma AVP may be secreted as a response to raised ICP in an effort to raise MAP and maintain cerebral perfusion pressure. In this setting excess fluid may be inappropriately retained, leading to hyponatremia and hypo-osmolemia.
Cotton
M F
MF
Department of Pediatrics and Child Health, University of Stellenbosch, Republic of South Africa.
Donald
P R
PR
Schoeman
J F
JF
Van Zyl
L E
LE
Aalbers
C
C
Lombard
C J
CJ
D000995:Antitubercular Agents / Q000627:therapeutic use*; D001127:Arginine Vasopressin / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D004232:Diuretics / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D007223:Infant; D007427:Intracranial Pressure / Q000187:drug effects* / Q000502:physiology; D008297:Male; D011446:Prospective Studies; D014390:Tuberculosis, Meningeal / Q000188:drug therapy* / Q000503:physiopathology; D014882:Water-Electrolyte Balance / Q000187:drug effects / Q000502:physiology
D000995:Antitubercular Agents; D004232:Diuretics; D001127:Arginine Vasopressin