Alpha-atrial natriuretic peptide, aldosterone secretion and plasma renin activity during ethanol withdrawal: a correlation with the onset of delirium tremens?

It is well established that changes in fluid and electrolyte homeostasis may accompany and are likely to modify the clinical symptoms of alcohol withdrawal reactions. It was of obvious theoretical and practical interest, therefore, to investigate the changes in the secretion of hormones which regulate the fluid and electrolyte homeostasis [alpha-atrial natriuretic peptide (alpha-ANP), aldosterone (ALDO) and plasma renin activity (PRA)], together with the changes in the serum electrolytes (sodium, potassium) in male chronic alcoholic inpatients. The patients were transferred to the hospital because of severe alcohol withdrawal reactions. Blood samples were taken on Day 1 (severe withdrawal) and Day 10 (partial recovery from withdrawal) of hospitalization. The peptide and steroid hormones were measured with RIA (radioimmunoassay), while flame photometry was used to measure the electrolytes in the serum. At the time of hospital admission, there was an increased PRA and ALDO level observed. Ten days later, the elevated PRA and ALDO levels were greatly reduced and thus they were back to the normal range. In 60% of the patients, delirium tremens has gradually developed during the observation period. In these patients, an elevated level of alpha-ANP was observed at the time of hospital admission, i.e., days before actual onset of delirium tremens. It is concluded that the disturbed volume homeostasis and the consequently altered alpha-ANP secretion might be associated with and therefore used as an indicator of the onset of delirium tremens.