[Inadequate secretion of atrial natriuretic peptide in children with acute brain injury].
OBJECTIVE
Fluid and electrolyte disturbances are frequent after acute brain damage. Atrial natriuretic peptide (ANP), which can also be found in brain tissue, could be a hormone implicated in such disorders (cerebral salt wasting syndrome).


METHODS
Plasma ANP levels were analyzed in 50 children with acute neurological deterioration (secondary to traumatic, infectious, convulsive tumor or vascular disorders) evaluated according to the modified Glasgow Coma Scale (GCS). Hemodynamic stability was determined by standard monitoring. ANP, renin and aldosterone levels were determined by RIA and the results compared with a control group of healthy children.


RESULTS
There was an increase in ANP levels in children with brain injury in comparison to the control group (p < 0.001), but not in children under one year of age. Renin and aldosterone were also significantly increased in this group of patients, with no difference in ANP, renin or aldosterone level found in function of their GCS score. All patients were hemodynamically stable and no correlation between hemodynamic and hormone variables was seen. Mechanical ventilation did not influence the hormone levels.


CONCLUSIONS
There is an important increase in ANP levels in patients with acute neurological pathologies, but it was not related to the hemodynamic condition and its importance has yet to be established. One of its possible consequences is a secondary hypotonic/hypovolemic condition, a potentially dangerous event for the patient with intracranial hypertension that needs immediate treatment. Differentiation of this syndrome from inappropriate vasopressin secretion could be very important in children with acute brain injury.
Ibarra de la Rosa
I
I
Departamento de Pediatría, Hospital Universitario Reina Sofía, Córdoba.
Pérez Navero
J L
JL
Palacios Córdoba
A
A
Montero Schiemann
C
C
Montilla López
P
P
Romanos Lezcano
A
A
D000208:Acute Disease; D009320:Atrial Natriuretic Factor / Q000172:deficiency* / Q000378:metabolism*; D001930:Brain Injuries / Q000175:diagnosis / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D011446:Prospective Studies
D009320:Atrial Natriuretic Factor
Secreción inadecuada de péptido natriurético auricular en niños con daño cerebral agudo.