Summary
The effect of haemorrhage on endocrine function and the anti-shock effects of methylprednisolone were investigated in 32 mongrel dogs. Plasma concentrations of antidiuretic hormone (ADH), epinephrine, norepinephrine, aldosterone and cortisone were measured simultaneously during and following haemorrhagic hypotension. Other parameters, such as urine volume and osmolality, serum and urine electrolytes and blood glucose were also determined simultaneously during the procedure. Dogs anaesthetized with pentobarbitone were bled so that the mean arterial pressure decreased to 50 mm Hg, which was maintained for 15 minutes (group one) or for 30 minutes (groups two, three, and four). After the recovery of group one animals from the first hypotension by reinfusion of blood and hydroethylstarch, they were bled again to a mean arterial pressure of 50 mm Hg (second hypotension) and were allowed to remain at this pressure. In groups two, three and four there was no second hypotension.
Plasma ADH concentrations were elevated 50 times control values on the first hypotension, but no appreciable increase was observed on the second hypotension. Plasma levels of epinephrine, norepinephrine and aldosterone increased 35, 7, and 5 times respectively during the first hypotension and 40, 10, and 5 times during the second hypotension, as compared to controls. Plasma osmolality correlated well with plasma ADH levels during the haemorrhage. Increased concentrations of plasma ADH, epinephrine and norepinephrine following haemorrhage had a tendency to decrease after the administration of fluids, but they were still higher than the preshock control levels. Methylprednisolone 15 mg/kg or 30 mg/kg administered intravenously before infusion of blood and hydroethylstarch caused a significant decrease of plasma levels of ADH and epinephrine to pre-shock control levels. Our data suggest that the administration of methylprednisolone could be beneficial in improving the shock state from an endocrinological point of view.
Résumé
Ľinfluence ďun choc hémorragique sur la fonction endocrinienne et ľeffet antichoc de la méthylprednisolone ont été étudiés chez le chien. Trente-deux animaux formant quatre groupes ont été utilisés.
Nous avons mesuré pendant et après une hypotension par saignée les concentrations plasmatiques ďADH, ďépinéphrine, de norépinéphrine, ďaldostérone et de Cortisol, la glycémie, ainsi que le volume et ľosmolalité urinaire et, enfin, les électrolytes sériques et urinaires.
Après une anesthésie au pentobarbital, les chiens ont été saignés de façon à abaisser la pression moyenne à 50 mm Hg; cette pression a été maintenue 15 minutes chez les animaux du premier groupe, et 30 minutes chez ceux des trois derniers groupes, Après correction de ľhypotension au moyen de sang et ďune solution colloïdale (“hydroéthylstarch”), les animaux du premier groupe ont été saignés une deuxième fois jusqu’ à ce que la pression moyenne redescende à 50 mm, pression où ils ont été laissés. Après correction de leur hypotension, les animaux des trois derniers groupes n’ont pas été soumis è un deuxième épisode ďhypotension.
Le taux ďADH plasmatique était 50 fois plus élevé que le taux des contrôles, au cours du premier épisode hypotensif, mais ľon n’a pas observé ďaugmentation appréciable au cours du second épisode. Comparés aux contrôles, les niveaux plasmatiques ďépinéphrine, de norépinéphrine et ďaldostérone étaient respectivement 35, sept et cinq fois plus grands au cours de la première hypotension et 40, dix et cinq fois plus grands au cours de la seconde. Les modifications de ľosmolalité urinaire coincidaient avec celles de ľADH. Les taux plasmatiques ďADH, ďépinéphrine et de norépinéphrine élevés après la saignée, avaient tendance à diminuer après ľadministration de volume, mais demeuraient plus élevés que les contrôles.
Une dose de 15 ou de 30 mg/kilo de méthylprednisolone administrée par voie intraveineuse avant la correction liquidienne (sang + colloïdes) était suivie ďune diminution significative des taux ďADH et ďépinéphrine jusqu’aux niveaux contrôles. Nos résultats suggèrent que le méthylprednisolone peut avoir des effets bénéfiques au point de vue hormonal dans le choc.
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Oyama, T., Matsuki, A., Kudo, T. et al. Effect of corticosteroids on endocrine function in haemorrhagic shock. Canad. Anaesth. Soc. J. 25, 7–17 (1978). https://doi.org/10.1007/BF03006776
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DOI: https://doi.org/10.1007/BF03006776