title: A randomized controlled trial of hydrocortisone against hyponatremia in patients with aneurysmal subarachnoid hemorrhage.
abstract: 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.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Katayama
authors.forename: Jo
authors.initials: J
authors.lastname: Haraoka
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Hirabayashi
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Kawamata
authors.forename: Keiji
authors.initials: K
authors.lastname: Kawamoto
authors.forename: Takao
authors.initials: T
authors.lastname: Kitahara
authors.forename: Jun
authors.initials: J
authors.lastname: Kojima
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kuroiwa
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Mori
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Moro
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
authors.forename: Kikuo
authors.initials: K
authors.lastname: Ohno
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Seiki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: Akira
authors.initials: A
authors.lastname: Teramoto
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
mesh_terms: 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*
chemical_list: D000893:Anti-Inflammatory Agents; D012964:Sodium; D006854:Hydrocortisone