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vasopressin-induced hyponatremia in an adult normotensive trauma patient:A case report

World Journal of Critical Care Medicine 2023年第1期12卷 35-40页

作者： Maulik K Lathiya Emily Pepperl Daniel Schaefer Hussam Al-Sharif Adel Zurob Susan M Cullinan Antonios Charokopos Department of Emergency Medicine Mayo Clinic Health SystemEau ClaireWI 54703United States Department of Pulmonary and Critical Care Medicine Mayo Clinic Health SystemEau ClaireWI 54703United States

BACKGROUND Arginine vasopressin is a neuropeptide produced in the hypothalamus and released by the posterior pituitary gland.In addition to maintaining plasma osmolarity,under hypovolemic or hypotensive conditions,it helps maintain plasma volume through renal water reabsorption and increases systemic vascular tone.Its synthetic analogues are widely used in the intensive care unit as a continuous infusion,in addition to hospital floors as an intravenous or intranasal dose.A limited number of cases of hyponatremia in patients with septic or hemorrhagic shock have been reported previously with vasopressin.We report for the first time a normotensive patient who developed vasopressin-induced hyponatremia.CASE SUMMARY A 39-year-old man fell off a forklift and sustained an axial load injury to his cranium.He had no history of previous trauma.Examination was normal except for motor and sensory deficits.The Imagine test showed endplate fracture at C7 and acute traumatic disc at C7 with cortical degeneration.He underwent cervical discectomy and fusion,laminectomy,and posterior instrumented fusion.After intensive care unit admission post-surgery,he developed hyponatremia of 121-124 mEq/L post phenylephrine and vasopressin infusion to maintain blood pressure maintenance.He was evaluated for syndrome of inappropriate secretion of antidiuretic hormone,hypothyroid,adrenal-induced,or diuretic-induced hyponatremia.At the end of extensive evaluation for the underlying cause of hyponatremia,vasopressin was discontinued.He was also put on fluid restriction,given exogenous desmopressin,and a dextrose 5%in water infusion to prevent osmotic demyelination syndrome caused by sodium overcorrection which improved his sodium level to 135 mmol/L.CONCLUSION The presentation of vasopressin-induced hyponatremia is uncommon in normotensive patients,and the most difficult aspect of this condition is determining the underlying cause of hyponatremia.Our case illustrates that,considering the vast differential diagnosis of hyponatremia in hospitalize

关键词： Hyponatremia vasopressin Normotensive Therapy Case report

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vasopressin decreases neuronal apoptosis during cardiopulmonary resuscitation

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Neural Regeneration Research 2014年第6期9卷 622-629页

作者： Chi Ma Zhe Zhu Xu Wang Gang Zhao Xiaoliang Liu Rui Li Department of Neurosurgery the First Hospital Jilin University Center for Hand and Foot Surgery and Reparative and Reconstructive Surgery Orthopedics Hospital the Second Hospital Jilin University Department of Neurology the First Hospital Jilin University Emergency Medicine the First Hospital Jilin University

The American Heart Association and the European Resuscitation Council recently recommend- ed that vasopressin can be used for cardiopulmonary resuscitation, instead of epinephrine. However, the guidelines do not discuss the effects of vasopressin during cerebral resuscitation. In this study, we intraperitoneally injected epinephrine and/or vasopressin during cardiopul- monary resuscitation in a rat model of asphyxial cardiac arrest. The results demonstrated that, compared with epinephrine alone, the pathological damage to nerve cells was lessened, and the levels of c-Iun N-terminal kinase and p38 expression were significantly decreased in the hippo- campus after treatment with vasopressin alone or the vasopressin and epinephrine combination. No significant difference in resuscitation effects was detected between vasopressin alone and the vasopressin and epinephrine combination. These results suggest that vasopressin alone or the vasopressin and epinephrine combination suppress the activation of mitogen-activated protein kinase and c-Iun N-terminal kinase signaling pathways and reduce neuronal apoptosis during cardiopulmonary resuscitation.

关键词： nerve regeneration brain injury cardiopulmonary resuscitation epinephrine vasopressin c-Jun N-terminal kinase p38 mitogen activated protein kinase cardiac arrest neural regeneration

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Arginine vasopressin-Aquaporin-2 Pathway-Mediated Dehydration Effects of Electroacupuncture in Guinea Pig Model of AVP-Induced Endolymphatic Hydrops

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Chinese Journal of Integrative Medicine 2019年第10期25卷 763-769页

作者： JIANG Li-yuan HE Jiao-jun CHEN Xi-xi SUN Xue-jiao WANG Xue-zhong ZHONG Shan CHEN Hua-de Departm ent of Acupuncture and Moxibustion the Third Clinical Medical College of Zhejiang Chinese Medical University Hangzhou (310053) China Department of Acupuncture and Rehabilitation Guangxing Hospital Affiliated to Zhejiang Chinese Medical University Hangzhou (310007) China

Objective: To investigate the effects of electroacupuncture(EA) on endolymphatic hydrops(EH) and the regulation of arginine vasopressin(AVP)-aquaporin-2(AQP2) pathway in guinea pigs. Methods: EH was induced in male guinea pigs by an intraperitoneal injection of AVP. For the treatment, EA was delivered to Baihui(GV 20) and Tinggong(SI 19) acupoints, once per day for 10 consecutive days. In histomorphological studies, cochlear hydrops degree was evaluated by hematoxylin-eosin(HE) staining, and then the ratio of scala media(SM) area to SM + scala vestibuli(SV) area(R value) was calculated. In mechanical studies, a comparison of plasma AVP(p-AVP) concentrations, cyclic adenosine monophosphate(cAMP) levels, vasopressin type 2 receptor(V2R) and AQP2 mRNA expressions in the cochlea were compared among groups. Results: EA significantly reduced cochlear hydrops in guinea pigs(P=0.001). EA significantly attenuated the AVPinduced up-regulation of p-AVP concentrations(P=0.006), cochlear c AMP levels(P=0.003) and AQP2 mRNA expression(P=0.016), and up-regulated the expression of V2R mRNA(P=0.004) in the cochlea. Conclusion: The dehydrating effect of EA might be associated with its inhibition of AVP-AQP2 pathway activation.

关键词： endolymphatic hydrops electroacupuncture arginine vasopressin (AVP)-aquaporin-2 (AQP2) pathway Meniere's disease

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Paraventricular Nucleus P2X7 Receptors Aggravate Acute Myocardial Infarction Injury via ROS-Induced vasopressin-V1b Activation in Rats

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Neuroscience Bulletin 2021年第5期37卷 641-656页

作者： Wenjing Cheng Yinggang Sun Qin Wu Kokwin Ooi Yi Feng Chunmei Xia Danian Zhu Department of Physiology and Pathophysiology School of Basic Medical SciencesFudan UniversityShanghai 200032China Department of Cardiovascular Diseases Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092China Department of Medical Technology Jiangsu Vocational College of MedicineYancheng 224005China Department of Integrative Medicine and Neurobiology School of Basic Medical SciencesFudan UniversityShanghai 200032China

The present study was designed to investigate the mechanisms by which P2X7 receptors(P2X7Rs)mediate the activation of vasopressinergic neurons thereby increasing sympathetic hyperactivity in the paraventricular nucleus(PVN) of the hypothalamus of rats with acute myocardial ischemia(AMI). The left anterior descending branch of the coronary artery was ligated to induce AMI in rats. The rats were pretreated with BBG(brilliant blue G, a P2X7R antagonist), nelivaptan(a vasopressin V1b receptor antagonist), or diphenyleneiodonium(DPI) [an nicotinamide adenine dinucleotide phosphate(NADPH)oxidase inhibitor]. Hemodynamic parameters of the heart were monitored. Myocardial injury and cardiomyocyte apoptosis were assessed. In the PVN of AMI rats, P2X7R mediated microglial activation, while reactive oxygen species(ROS) and NADPH oxidase 2(NOX2) were higher than in the sham group. Intraperitoneal injection of BBG effectively reduced ROS production and vasopressin expression in the PVN of AMI rats. Moreover, both BBG and DPI pretreatment effectively reduced sympathetic hyperactivity and ameliorated AMI injury, as represented by reduced inflammation and apoptosis of cardiomyocytes.Furthermore, microinjection of nelivaptan into the PVN improved cardiac function and reduced the norepinephrine(AE) levels in AMI rats. Collectively, the results suggest that, within the PVN of AMI rats, P2X7R upregulation mediates microglial activation and the overproduction of ROS, which in turn activates vasopressinergic neuron V1b receptors and sympathetic hyperactivity, hence aggravating myocardial injury in the AMI setting.

关键词： PVN P2X7 receptor vasopressin Reactive oxygen species c-fos Myocardial ischemia

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Effect of electroacupuncture on arginine vasopressin-induced endolymphatic hydrops

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Journal of Traditional Chinese Medicine 2019年第2期39卷 221-228页

作者： Jiang Liyuan He Jiaojun Chen Xixi Chen Huade Department of Acupuncture and Rehabilitation Hangzhou Hospital of Traditional Chinese Medicine (Guangxing Hospital Affiliated to Zhejiang Chinese MedicalUniversity) Department of Acupuncture and Moxibustion The Third Clinical Medical College Zhejiang Chinese Medical University

OBJECTIVE: To investigate the influence of electroacupuncture(EA) on experimentally induced endolymphatic hydrops(EH) in guinea pigs, and elucidate the association between the dehydrating effect of EA and changes in stria vascularis ultrastructure and expression of vasopressin type 2 receptor(V2R), cyclic adenosine monophosphate(cAMP),and aquaporin 2(AQP2) in the endolymphatic sac(ES).METHODS: The EH model was established by intraperitoneal injection of arginine vasopressin(AVP).As a treatment, EA was delivered to Baihui(GV 20)and Tinggong(SI 19) acupoints, once daily for 10 consecutive days. For histomorphological studies,degree of cochlear hydrops was evaluated by hematoxylin-eosin staining, and the ratio of scala media(SM) area to SM + scala vestibuli area was calculated. In mechanical studies, ultrastructural changes in stria vascularis tissue were examined by transmission electron microscopy. In addition, cAMP levels and mRNA expression levels of V2 R and AQP2 in the ES were compared among groups.RESULTS: EA treatment significantly reduced cochlear hydrops compared with hydropic guinea pigs(P = 0.015). Furthermore, EA attenuated ultrastructural changes in the stria vascularis tissue following EH, significantly upregulated the expression of V2 R(P = 0.016), and attenuated AVP-induced upregulation of both cAMP(P = 0.038) and AQP2 expression(P = 0.017) in the ES.CONCLUSION: Collectively, the results of the present study suggest that the dehydrating effect of EA is associated with improvement of stria vascularis ultrastructure and V2 R-cAMP-AQP2 signaling pathway regulation in the ES.

关键词： Meniere disease Electroacupuncture Endolymphatic hydrops Arginine vasopressin Receptors,vasopressin Cyclic AMP Aquaporin 2

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EFFECT OF ARGININE vasopressin ON LEARNING PROCESS FOLLOWING TRANSECTION OF FIMBRIA-FORNIX IN MICE

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Chinese Science Bulletin 1991年第16期36卷 1388-1392页

作者：梅镇彤黄毅蒋芝华段书慧 Shanghai Institute of Physiology Academia Sinica Shanghai 200031 PRC

Arginine vasopressin (AVP) is an endogenous neuropeptide that has been reported to enhance the acquisition of active avoidance behavior in mice and light-dark discrimination learning in rats. In addition, our previous work reported the modulating effect of AVP on hippocampal neuronal activity. Thus, it was suggested that hippocampus may be one of the CNS sites mediating the enhancing effect of AVP on acquisition. As we know, the fimbria-fornix is the main afferent and efferent pathways of hippocampus. Accordingly,

关键词： fimbria-fornix arginine vasopressin learning process mouse.

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Arginine vasopressin as a target in the treatment of acute heart failure

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World Journal of Cardiology 2014年第12期6卷 1252-1261页

作者： Nisha A Gilotra Stuart D Russell Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MD 21287 United States

Congestive heart failure(CHF) is one of the most common reasons for hospitalization in the United States. Despite multiple different beneficial medications for the treatment of chronic CHF, there are no therapies with a demonstrated mortality benefit in the treatment of acute decompensated heart failure. In fact, studies of inotropes used in this setting have demonstrated more harm than good. Arginine vasopressin has been shown to be up regulated in CHF. When bound to the V1 a and/or V2 receptors, vasopressin causes vasoconstriction, left ventricular remodeling and free water reabsorption. Recently, two drugs have been approved for use that antagonize these receptors. Studies thus far have indicated that these medications, while effective at aquaresis(free water removal), are safe and not associated with increased morbidity such as renal failure and arrhythmias. Both conivaptan and tolvaptan have been approved for the treatment of euvolemic and hypervolemic hyponatremia. We review the results of these studies in patients with heart failure.

关键词： vasopressin Arginine remodeling mortality placebo heartfailure approved morbidity stimulation natriuretic

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Clinical trials comparing norepinephrine with vasopressin in patients with septic shock:A meta-analysis

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Journal of Medical Colleges of PLA(China) 2014年第1期29卷 44-50页

作者： Fei-Hu Zhou Qing Song Department of Critical Care Medicine the Chinese PLA General Hospital

Background: To compare the mortality rates and benefits of norepinephrine and vasopressin in patients with septic shock. Methods: PubMed, EMBASE, and the Cochrane Library database were searched from database inception to December 2013. We selected randomized controlled trials in adults with septic shock and compared norepinephrine with vasopressin. After assessing the heterogeneity of treatment effects across trials using the I2 statistic, we used a fixed effects model(P≥0.1) and expressed the results as risk ratios(RRs) for dichotomous outcomes or as standardized mean differences(SMDs) for continuous data with 95% confidence intervals(CIs). Meta-analysis was conducted using Review Manager 5.1 software.Results: Seven trials(n=2323) met the inclusion criteria. Overall, the mortality rate in these seven trials was 36.2%(840/2323). There was no difference in mortality following the use of norepinephrine or vasopressin(RR 1.07; 95%CI 0.97-1.20; P=0.19). Compared to norepinephrine, vasopressin had no significant effect on heart rate(HR)(SMD 0.21; 95%CI-0.08-0.50; P=0.15), mean arterial pressure(MAP)(SMD 0.15; 95%CI-0.15-0.44; P=0.33), cardiac index(CI)(SMD-0.10; 95%CI-0.64-0.44; P=0.73), systemic vascular resistance index(SVRI)(SMD 0.15; 95%CI-0.39-0.70; P=0.58), oxygen delivery(DO2)(SMD-0.06; 95%CI-0.62-0.49; P=0.82), oxygen consumption(VO2)(SMD 0.03; 95%CI-0.52-0.59; P=0.91) or lactic acid(SMD 0.07; 95%CI-0.23-0.36; P=0.66). No significant heterogeneity was found in these comparisons(P≥0.1).Conclusions: There is not sufficient evidence to prove conclusively that norepinephrine is superior to vasopressin in terms of mortality and hemodynamics. The effects of norepinephrine and vasopressin on patients with septic shock require further study in large randomized controlled trials.

关键词： norepinephrine vasopressin sepsis shock meta-analy

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Messenger RNA expressions of vasopressin system and aquaporin 2 in adriamycin induced nephrotic rats and effects of astragalus membranaceus

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Chinese Medical Journal 1999年第12期 12-16页

作者：马骥樊淑玲陈靖顾勇林善锬

Objective To investigate the expressions of hypothalamic arginine vasopressin (AVP) mRNA, renal AVP V 2 receptor mRNA, and AVP dependent aquaporin 2 (AQP 2) mRNA in rats with adriamycin induced nephrotic syndrome Effects of Chinese herb Astragalus membranaceus (AM) were also tested Methods Sprague Dawley rats with four weeks of adriamycin induced nephrotic syndrome (NS) were used in this study Another group NS+AM was set to testify the effects of AM given 0 5?g/kg daily on NS Hypothalamic AVP mRNA expression was examined by dot blot method Reverse transcription polymerase chain reaction was applied for detection of renal cortical and medullary V 2 receptor and AQP 2?mRNA The results were normalized by mRNA of glyceraldehyde 3 phosphate dehydrogenase from the same sample Results All rats receiving adriamycin presented typical nephrosis No obvious difference in plasma osmolality was detected among NS, NS+AM, and normal control (NC) rats Hypothalamic AVP mRNA expression was higher in NS rats than NC (53 59±5 49 vs 25 72±1 96, P <0 01) AM completely reversed this up regulated expression (21 88±1 25) In both cortex and medulla of the kidney, nephrotic rat had increased AVP V 2 expressions by 169% and 55%, respectively, compared with normal control rat The increment of expression of AQP 2?mRNA was consistent with that of V 2 receptor in NS rat AM could partially however significantly correct these up regulations of V 2 and AQP 2?mRNA expressions ( P <0 01) Conclusion The up regulated mRNA expressions of hypothalamic AVP, renal V 2 receptor and AQP 2 might play a role in edema formation in adriamycin induced nephrotic rats AM exerts its therapeutical effects on nephrosis partially through this mechanism

关键词： nephrotic syndrome vasopressin aquaporin astragalus membranaceus

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A Case of Type I Hepatorenal Syndrome Treated with vasopressin

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Open Journal of Nephrology 2013年第3期3卷 135-138页

作者： Laura Connor Geoffrey Teehan Department of Internal Medicine Lankenau Medical Center Wynnewood USA Department of Nephrology Lankenau Medical Center Wynnewood USA

Hepatorenal syndrome (HRS) is a grave complication of end-stage liver disease and is associated with a very high mortality. This case report described a 42-year-old female with advanced alcohol-induced cirrhosis who developed HRS that was initially treated with Midodrine and Octreotide but renal function continued to deteriorate. vasopressin therapy was added and HRS was successfully reversed. There are few data available on the use of vasopressin for HRS and this case supports its use in treatment of HRS, particularly in countries where the more widely studied Terlipressin is unavailable. This case also demonstrates that a patient failing one medical therapy for HRS may respond to an alternative or adjunctive therapy. Therefore, this should be attempted to increase the patient’s chance of survival.

关键词： Hepatorenal Syndrome vasopressin

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