title: Is the circulating plasma volume sufficiently maintained? Fluid management of an aneurysmal subarachnoid hemorrhage in the acute phase.
abstract: Cerebral vasospasm is a well-known cause of mortality and morbidity following aneurysmal subarachnoid hemorrhage (SAH). Prevention of symptomatic cerebral vasospasm is the basic management after SAH. Numerous pharmaceutical therapies and endovascular treatments are available against  cerebral vasospasm, but none of them have so far proven to improve the outcome. We have focused on maintaining the circulation volume in order to prevent cerebral vasospasm. But to maintain the central venous pressure, huge infusion volume was required, and hyponatremia was frequently observed  due to natriuresis and osmotic diuresis. Excessive natriuresis and diuresis cannot be managed through sodium and water replacement, since sodium replacement induces further natriuresis and diuresis (desalination), and water replacement induces hyponatremia. We therefore administered fludrocortisone  and hydrocortisone to inhibit excessive natriuresis and diuresis. The efficacy of sodium reabsorption therapy is extremely high to maintain the circulation volume that might have a therapeutic effect to prevent cerebral vasospasm. In this article, we review our institution's experience  regarding the management of patients with aneurysmal SAH and also discuss the importance of water and sodium balance when managing such patients.
authors.affiliation: Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan. mori.tatsurou@nihon-u.ac.jp
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Mori
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Katayama
authors.forename: Takahiro
authors.initials: T
authors.lastname: Igarashi
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Moro
authors.forename: Jun
authors.initials: J
authors.lastname: Kojima
authors.forename: Teruyasu
authors.initials: T
authors.lastname: Hirayama
mesh_terms: D000208:Acute Disease; D000818:Animals; D002496:Central Venous Pressure / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D019468:Disease Management; D005440:Fluid Therapy / Q000379:methods* / Q000592:standards; D006801:Humans; D010953:Plasma Volume / Q000502:physiology*; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors