Department of Critical Care Services, Maine Medical Center, Portland, ME, USA.
Neuroscience Institute and Department Critical Care Services, Maine Medical Center, Portland, ME, USA.
J Pharm Pract. 2023 Jun;36(3):689-694. doi: 10.1177/08971900211053497. Epub 2021 Oct 21.
Vasopressin may be administered to treat vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). The objectives of this study were to describe five cases of suspected vasopressin-induced hyponatremia after aSAH and to review the literature. Single-center, observational case series of intensive care unit (ICU) patients. Ten-bed neurological ICU at Maine Medical Center in Portland, Maine. Convenience sample of patients with aSAH treated with a vasopressin for symptomatic, radiologically confirmed vasospasm. A total of five patients were included in the case series with a median age of 57 (51, 65) years and all were women. The median Glasgow coma scale score was 15 (11, 15) on admission, and the Hunt and Hess scale score was 3, (3, 4). All patients were treated with endovascular coiling of their aneurysm. Vasopressin was administered to treat symptomatic, radiographically confirmed vasospasm on median post-bleed day (PBD) 10 (10, 15) at a fixed-dose of .03 units/min. Serum sodium at baseline was 140 (140, 144) mEq/L and decreased to 129 (126, 129) mEq/L within 26 (17, 83) hours of vasopressin initiation for a median change of -16 (-10, -16) mEq/L. Serum sodium returned to baseline within 18 (14, 22) hours of stopping the infusion. Vasopressin use in vasospasm after aSAH may be associated with clinically significant hyponatremia within 24 hours of starting the infusion. Hyponatremia appears to resolve within 24 hours of stopping the infusion. Additional study in a larger sample size is needed to determine if a causal relationship exist.
加压素可用于治疗蛛网膜下腔出血（aSAH）后的血管痉挛。本研究的目的是描述 5 例疑似加压素诱导的 aSAH 后低钠血症，并复习文献。
单中心、观察性 ICU 病例系列。
缅因州波特兰缅因州医疗中心的 10 床神经科 ICU。
方便选择接受加压素治疗症状性、放射学证实的血管痉挛的 aSAH 患者。
共有 5 例患者纳入病例系列，中位年龄为 57 岁（51、65），均为女性。入院时格拉斯哥昏迷评分中位数为 15（11、15），Hunt 和 Hess 评分中位数为 3（3、4）。所有患者均接受血管内动脉瘤夹闭治疗。在中位出血后第 10 天（10、15），以 0.03 单位/分钟的固定剂量给予加压素治疗症状性、放射学证实的血管痉挛。基线时血清钠浓度为 140（140、144）mEq/L，在开始使用加压素后 26（17、83）小时内降至 129（126、129）mEq/L，中位数变化为-16（-10、-16）mEq/L。停止输注后 18（14、22）小时内血清钠恢复至基线。
aSAH 后血管痉挛使用加压素可能与开始输注后 24 小时内出现临床显著低钠血症相关。低钠血症似乎在停止输注后 24 小时内得到解决。需要在更大的样本量中进行进一步研究，以确定是否存在因果关系。
