• Yoichi Katayama, Jo Haraoka, Hidehiro Hirabayashi, Tatsuro Kawamata, Keiji Kawamoto, Takao Kitahara, Jun Kojima, Toshihiko Kuroiwa, Tatsuro Mori, Nobuhiro Moro, Izumi Nagata, Akira Ogawa, Kikuo Ohno, Yoshikatsu Seiki, Yoshiaki Shiokawa, Akira Teramoto, Teiji Tominaga, and Toshiki Yoshimine.
• Stroke. 2007 Aug 1;38(8):2373-5.

Background And PurposeHyponatremia is common after aneurysmal subarachnoid hemorrhage (SAH). It is caused by natriuresis, which induces osmotic diuresis and decreases blood volume, contributing to symptomatic cerebral vasospasm (SCV). Hypervolemic therapy to prevent SCV will not be efficient under this condition. We conducted a randomized controlled trial to assess the efficacy of hydrocortisone, which promotes sodium retention in the kidneys.MethodsSeventy-one SAH patients were randomly assigned after surgery to treatment with either a placebo (n=36) or 1200 mg/d of hydrocortisone (n=35) for 10 days and tapered thereafter. Both groups underwent hypervolemic therapy. The primary end point was the prevention of hyponatremia.ResultsHydrocortisone prevented excess sodium excretion (P=0.04) and urine volume (P=0.04). Hydrocortisone maintained the targeted serum sodium level throughout the 14 days (P<0.001), and achieved the management protocol with lower sodium and fluid (P=0.007) supplementation. Hydrocortisone kept the normal plasma osmolarity (P<0.001). SCV occurred in 9 patients (25%) in the placebo group and in 5 (14%) in the hydrocortisone group. No significant difference in the overall outcome was observed between the 2 groups.ConclusionsHydrocortisone overcame excess natriuresis and prevented hyponatremia. Although there was no difference in outcome, hydrocortisone supported efficient hypervolemic therapy.

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