Nonosmotic stimuli alter osmoregulation in patients with spinal cord injury

Hugh H. Williams, Barry Wall, Jeanne M. Horan, Daniel N. Presley, Joan T. Crofton, Leonard Share, C. Robert Cooke

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Studies on two quadriplegic patients who developed severe hyponatremia during episodes of acute respiratory distress were performed to determine whether differences in osmoregulation of vasopressin release could be identified in these patients compared to other quadriplegic subjects previously studied in a similar manner. Both patients were clinically stable and normonatremic, with no signs or symptoms of respiratory distress, when the studies were performed. However, both exhibited evidence of hemodynamic instability in the sitting posture. Linear regression analysis of the plasma vasopressin/plasma osmolality (Pavp:Posm) relationship during infusions of 0.85M sodium chloride showed no significant differences in either the slope (sensitivity) or abscissal intercept (osmotic threshold) of this relationship compared to that of other quadriplegic subjects when the patients were supine. In contrast, when the patients were studied in the sitting posture there was a marked shift in the relationship of Pavp:Posm indicative of increased sensitivity and reduced osmotic threshold for vasopressin release. The slopes of the Pavp:Posm relationships were 0.249 and 0.178 for the two patients, respectively, compared to 0.092 ± 0.03 (±SD) for previously studied quadriplegic subjects. Oral water-loading studies performed on one patient revealed marked impairment of urine-diluting ability and free water clearance in the sitting posture compared with observations in similar studies performed when the patient was supine. Impairment of renal water excretion could not be attributed to an effect of vasopressin, which was reduced to unquantifiable levels by water loading. These studies have shown that hemodynamic stress related to autonomic dysfunction in quadriplegic patients may result in marked alteration of osmoregulation of vasopressin release in more severely affected individuals. Such altered osmoregulation, which may also be associated with vasopressin-independent impairment of renal water excretion in the sitting posture, may be a predisposing factor in the development of hyponatremia, especially in the presence of other potent nonosmotic stimuli.

Original languageEnglish (US)
Pages (from-to)1536-1543
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume71
Issue number6
DOIs
StatePublished - Jan 1 1990

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Osmoregulation
Vasopressins
Spinal Cord Injuries
Plasmas
Posture
Water
Osmolar Concentration
Hemodynamics
Hyponatremia
Respiratory Signs and Symptoms
Linear regression
Sodium Chloride
Regression analysis
Causality
Linear Models
Regression Analysis
Urine

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Williams, H. H., Wall, B., Horan, J. M., Presley, D. N., Crofton, J. T., Share, L., & Cooke, C. R. (1990). Nonosmotic stimuli alter osmoregulation in patients with spinal cord injury. Journal of Clinical Endocrinology and Metabolism, 71(6), 1536-1543. https://doi.org/10.1210/jcem-71-6-1536

Nonosmotic stimuli alter osmoregulation in patients with spinal cord injury. / Williams, Hugh H.; Wall, Barry; Horan, Jeanne M.; Presley, Daniel N.; Crofton, Joan T.; Share, Leonard; Cooke, C. Robert.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 71, No. 6, 01.01.1990, p. 1536-1543.

Research output: Contribution to journalArticle

Williams, HH, Wall, B, Horan, JM, Presley, DN, Crofton, JT, Share, L & Cooke, CR 1990, 'Nonosmotic stimuli alter osmoregulation in patients with spinal cord injury', Journal of Clinical Endocrinology and Metabolism, vol. 71, no. 6, pp. 1536-1543. https://doi.org/10.1210/jcem-71-6-1536
Williams, Hugh H. ; Wall, Barry ; Horan, Jeanne M. ; Presley, Daniel N. ; Crofton, Joan T. ; Share, Leonard ; Cooke, C. Robert. / Nonosmotic stimuli alter osmoregulation in patients with spinal cord injury. In: Journal of Clinical Endocrinology and Metabolism. 1990 ; Vol. 71, No. 6. pp. 1536-1543.
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