A randomized controlled trial of hydrocortisone against hyponatremia in patients with aneurysmal subarachnoid hemorrhage.
OBJECTIVE
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.
Katayama
Yoichi
Y
Haraoka
Jo
J
Hirabayashi
Hidehiro
H
Kawamata
Tatsuro
T
Kawamoto
Keiji
K
Kitahara
Takao
T
Kojima
Jun
J
Kuroiwa
Toshihiko
T
Mori
Tatsuro
T
Moro
Nobuhiro
N
Nagata
Izumi
I
Ogawa
Akira
A
Ohno
Kikuo
K
Seiki
Yoshikatsu
Y
Shiokawa
Yoshiaki
Y
Teramoto
Akira
A
Tominaga
Teiji
T
Yoshimine
Toshiki
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000009:adverse effects; D007010:Hyponatremia / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D020896:Hypovolemia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009318:Natriuresis / Q000187:drug effects* / Q000502:physiology; D012964:Sodium / Q000097:blood / Q000652:urine; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*
D000893:Anti-Inflammatory Agents; D012964:Sodium; D006854:Hydrocortisone