Secretion of brain natriuretic peptide in patients with aneurysmal subarachnoid haemorrhage

• Published in: The Lancet (British edition) 1997-01, Vol.349 (9047), p.245-249
• Main Authors: Berendes, Elmar, Walter, Michael, Cullen, Paul, Prien, Thomas, Aken, Hugo Van, Horsthemke, Jürgen, Schulte, Manfred, von Wild, Klaus, Scherer, Ralf
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Brain; Brain Neoplasms - metabolism; Brain Neoplasms - surgery; Cardenolides; Digoxin; Enzyme Inhibitors - blood; Female; Fluorescence Polarization Immunoassay; Hemorrhage; Humans; Hyponatremia - etiology; Intracranial Aneurysm - metabolism; Male; Medical research; Medical sciences; Middle Aged; Natriuretic Agents - blood; Natriuretic Peptide, Brain; Nerve Tissue Proteins - metabolism; Neurology; Peptides; Saponins - blood; Sodium; Sodium - metabolism; Sodium-Potassium-Exchanging ATPase - antagonists & inhibitors; Subarachnoid Hemorrhage - metabolism; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(96)08093-2

Subarachnoid haemorrhage is commonly associated with natriuresis and hyponatraemia. One possible explanation for these features is a defect in the central regulation of renal sodium reabsorption with increased secretion of a natriuretic factor. We investigated whether excess sodium secretion in patients with subarachnoid haemorrhage is related to increased secretion of natriuretic peptides or to the presence of digoxin-like immunoreactive substances. We measured the plasma concentrations of digoxin-like immunoreactive substances (by a fluorescence polarisation immunoassay) and natriuretic peptides, aldosterone, renin, and antidiuretic hormone (by radioimmunoassay) in ten patients with aneurysmal subarachnoid haemorrhage, ten patients undergoing elective craniotomy for cerebral tumours, and 40 healthy controls of similar age and sex distribution. Samples were collected before surgery, 1 h, 4 h, and 12 h after surgery, then daily until 7 days postoperatively in the two groups of patients. All patients with subarachnoid haemorrhage, but none of the tumour patients, showed increased urine output and urinary excretion of sodium (p=0·018 for comparison of means of curves to 7 days). The patients with subarachnoid haemorrhage had much higher plasma concentrations of brain natriuretic peptide (BNP) than controls, on admission (mean 15·1 [SE 3·8] vs 1·6 [1·0] pmol/L, p