Abstract
Chronic cervical spinal cord injury is characterized by defects in sodium and water homeostasis and defects of adaptive hormonal responses. The plasma osmolality is maintained in a relatively narrow range, the lower limit of which is determined by osmotic threshold for vasopressin release and the upper limit by the thirst threshold. Antidiuretic hormone as an important mediator of fluid and electrolyte balance was well investigated in able bodied children comparing children with normal voiding pattern and children with enuresis. The normal subjects were found to have higher plasma ADH at night, not detected in the group with enuresis. The findings were similar in elderly patients with increased diuresis at night, suggesting an important role of ADH in nocturnal decrease of urine output. Investigators studied the effect of rapid tilt on plasma ADH in tetraplegic compared with normal subjects, but there are no data available in the literature regarding ADH and its effects on water and electrolyte balance in healthy tetraplegic subjects with a normal lifestyle. We decided to undertake a pilot study to attempt to establish baseline ADH levels in this subject group, to better understand and manage tetraplegic patients with water and electrolyte dysregulation. Our preliminary data suggest that these individuals lack the normal diurnal variation of ADH, a phenomenon similar to that demonstrated in enuretic children and elderly, and furthermore appear to have generally depressed ADH levels.
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Kooner JS et al. Hemodynamic, hormonal and urinary responses to postural change in tetraplegic man. Paraplegia 1988; 26: 233–237.
Mathias CJ et al. The effect of desmopressin on nocturnal polyuria, overnight weight loss, and morning postural hypotension in patients with autonomic failure. BMJ 1986; 293: 353–354.
Williams HH et al. Nonosmotic stimuli alter osmoregulation in patients with spinal cord injury. J Clin Endocrinol Metab 1990; 71: 1536–1543.
Leehey DJ, Picache AA, Robertson GL . Hyponatremia in quadriplegic patients. Clin Sci 1988; 75: 441–444.
George CPL et al. Diurnal variation of plasma vasopressin in man. J Clin Endocrinol Metab 1975; 41: 332–338.
Mills JN . Diurnal rhythm in urine flow. J Physiol 1951; 113: 528–536.
Rittig S et al. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patient with enuresis. Am J Physiol 1989; 256: F664–671.
Norgaard JP, Pederson EB, Djurhuus JC . Diurnal antidiuretic hormone levels in enuretics. J Urol 1985; 134: 1029–1031.
Asplund R, Aberg H . Diurnal variation in the levels of antidiuretic hormone in the elderly. J Int Med 1991; 229: 131–134.
Skowsky WR, Rosenbloom AA, Fisher DA . Radioimmunoassay measurement of arginine vasopressin in serum: Development and application. J Clin Endocrinal Metab 1974; 38: 278.
Poole CJM, Williams TDM, Lightman SL, Frankel HL . Neuroendocrine control of vasopressin secretion and its effect on blood pressure in subjects with spinal cord transection. Brain 1987; 110: 727–735.
Wall BM et al. Altered sensitivity to osmotically stimulated vasopressin release in quadriplegic subjects. Am J Physiol 1990; 258: R827–835.
Sved AF, McDowell FH, Blessing WW . Release of antidiuretic hormone in quadriplegic subjects in response to head-up tilt. Neurology (Cleveland) 1985; 35: 78–82.
Mathias CJ, Frankel HL . Autonomic failure in tetraplegia. In: Bannister R (ed). Autonomic Failure Oxford University Press: Oxford, 1984, pp 454–488.
Mathias CJ et al. Plasma catecholamines, plasma renin activity and plasma aldosterone in tetraplegic man, horizontal and tilted. Clin Sci Mol Med 1975; 49: 291–299
Poole CJM, Williams TDM, Lightman SL, Frankel HL Neuroendocrine control of vasopressin secretion and its effect on blood pressure in subjects withspinal cord transection. Brain 1987; 110: 727–735
Ragnarsson KT et al. Head up tilt effect on glomeruler filtration rate, renal plasma flow, and mean arterial pressure in and plasma aldosterone in spinal man. Arch Phys Med Rehabil 1981; 62: 306–310.
Guyton A . Textbook of Medical Physiology. Philadelphia: Saunders, 1991.
Sutters et al. The cardiovascular, endocrine and renal response of tetraplegic and paraplegic subjects to dietary sodium restriction: J Physiol (Lond) 1992; 457: 515–523
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Szollar, S., North, J. & Chung, J. Antidiuretic hormone levels and polyuria in spinal cord injury. A preliminary report. Spinal Cord 33, 94–97 (1995). https://doi.org/10.1038/sc.1995.22
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DOI: https://doi.org/10.1038/sc.1995.22