J D Roscelli — Page 2 | Search PubMed

PubMed1985

Orthostatic heart rate and arterial blood pressure changes in normovolemic children.

Orthostatic heart rate and blood pressure changes were determined in 112 normovolemic children from two to 12 years of age. In normal children, two to eight years of age, and nine to 12 years of age, the heart rate may increase as much as 30 and 40 beats per minute, respectively, upon standing. The orthostatic systolic blood pressure change is independent of age and may, in normal children, fall as much as 27 mm Hg. The orthostatic diastolic blood pressure change, as determined by the fourth or fifth Korotkoff sounds, showed great variability, and probably will not be useful in the assessment of a child's intravascular volume status. Orthostatic changes in heart rate and blood pressure, within the above limits, cannot be used as evidence of hypovolemia, since these changes can occur in normovolemic children.

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PubMedDate not supplied

Inappropriate antidiuretic hormone in children with viral meningitis.

Urinary excretion rates of antidiuretic hormone were determined by radioimmunoassay in children with bacterial (6) and viral (11) meningitis, and in children with other febrile illnesses (7). These values were compared to normal data obtained from 50 healthy, normally hydrated children ranging in age from 1 week to 9 years. Plasma sodium concentrations were measured in the sick children; urine osmolality and creatinine concentrations were measured in all children. Upon admission, all children with bacterial meningitis and 64% of those with viral meningitis had urinary antidiuretic hormone excretion rates greater than 2 S.D. above values obtained from age-matched controls. Fifty-seven percent of children with other febrile illnesses had similarly elevated antidiuretic hormone values; however, only in the bacterial and viral meningitis groups were antidiuretic hormone excretion rates inappropriate because they occurred when serum sodium concentrations were found to be normal or low normal (i.e., 136 +/- 2 mEq/L and 137 +/- 1 mEq/L, respectively). The average serum sodium in the group with other febrile illnesses was higher (146 +/- 5 mEq/L; p less than 0.05) and could represent an appropriate stimulus for antidiuretic hormone release. In spite of high levels of antidiuretic hormone, most viral meningitis patients did not concentrate their urine, probably because all except 2 were younger than 2 months of age. We conclude that viral meningitis, like bacterial meningitis, frequently is associated with inappropriate antidiuretic hormone secretion; however, most children with viral meningitis may be protected from developing hyponatremia because of their inability to concentrate their urine.

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