PubMed · 13576846
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F D HART, J R GOLDING, D BURLEY. 1958-09-06. Triamcinolone.. https://doi.org/10.1016/s0140-6736(58)91284-4
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Hyponatremia, natriuresis, and a decrease in plasma volume of greater than 10% occurs in approximately 50% of the patients with aneurysmal SAH, perhaps due to SIADH and CSWS. However, fluid restriction, as indicated in SIADH, might result in vasospasm and cerebral infarction in these patients. Maintaining intravascular volume seems to be important in SAH; several reports suggest that cerebral ischemia can be reversed by use of volume expanders. Fludrocortisone has been shown to reduce natriuresis, which may help maintain plasma volume in patients with SAH. Adequate oral salt intake also appears to have possible therapeutic benefit in these patients. However, it remains unproven whether fludrocortisone results in a decreased incidence of cerebral ischemia. Larger controlled trials are needed to ascertain the impact of fludrocortisone on prevention of cerebral ischemia in patients with SAH.
Fludrocortisone has been a mainstay of therapy for orthostatic hypotension for many years. Clinical experience suggests that there exists a substantial interindividual variation in responsiveness to the drug. To assess this, we have developed an assay that permits measurement of the low concentrations of fludrocortisone found in human plasma. Fludrocortisone was detected by radioimmunoassay. A polyclonal rabbit antibody, raised against dexamethasone which cross-reacts strongly with fludrocortisone, was reacted with either standard or unknown samples in the presence of [125I]fludrocortisone-3-TyrNH2 (synthesized by coupling tyrosine amide to fludrocortisone-3-oxime and iodinating with chloramine T oxidation). The ED10, ED50, and ED80 were 0.34, 5.0, and 30 ng/mL of plasma, respectively. The cross reactivity with other 9-fluorinated steroids was found as follows: dexamethasone, 340%; betamethasone, 230%; and triamicinolone, 8%. To preclude an erroneous result, subjects who were pregnant or receiving any steroid medication were excluded from the study. The percent cross-reactivity with the main naturally occurring steroids was as follows: 11-desoxycortisol 3.2%, cortisol 1.1%, DOC 0.3%, pregnenolone 0.1%, corticosterone 0.06%, progesterone 0.05%, and aldosterone < 0.05%. The only compound with potential for interference, because of its high level in the circulation in the early morning, was cortisol.(ABSTRACT TRUNCATED AT 250 WORDS)
We have described a patient with severe rheumatoid arthritis and a history of mefenamic acid nephropathy in whom hyperkalemia and inappropriate hypoaldosteronism were caused by both indomethacin and naproxen, without major decline in renal function. It is likely that preexisting renal disease predisposed this patient to type IV renal tubular acidosis with prostaglandin synthetase inhibitors. Because he was unable to discontinue nonsteroidal anti-inflammatory drug therapy, fludrocortisone was added, correcting the hyperkalemia and allowing indomethacin therapy to be continued safely.