Chest
Volume 85, Issue 1, January 1984, Pages 49-54
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Hormonal Abnormalities Affecting Sodium and Water Balance in Acute Respiratory Failure Due to Chronic Obstructive Lung Disease

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The pathogenesis of edema and hyponatremia associated with chronic obstructive lung disease (COLD) is poorly understood. In ten edematous COLD patients with acute respiratory failure (ARF), we monitored plasma renin activity (PRA), aldosterone (PA), and antidiuretic hormone (arginine vasopressin, AVP) for six days. Six patients receiving supplemental oxygen and antibiotics had near normal PRA, PA, and AVP, and diuresed Na+ and H2O and lost weight; only one patient was hyponatremic (PNa+<130 mEq/L). On the same therapy, nonresponders (n = 4), with persistently elevated PRA, PA, and AVP, demonstrated no loss of Na+, H2O, or weight; three patients were hyponatremic. The PRA and PA correlated inversely with sodium loss; AVP correlated inversely with free water clearance. These studies suggest that in patients with COLD, edema, and ARF (1) lack of sodium diuresis may be contributed to by secondary hyperaldosteronism; and (2) hyponatremia can be explained by inappropriately elevated plasma AVP.

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MATERIALS AND METHODS

The studies were performed on ten patients, all men, mean age 57 ± 2 SE years, who presented with acute respiratory failure and met the following criteria:

  • (a)

    Chronic obstructive lung disease by standard tests of pulmonary function:4 total lung capacity (TLC) and specific airway conductance (SGaw) by body plethysmography; forced one second expiratory volume (FEV1) and forced vital capacity (FVC) by SRL computerized spirometer;

  • (b)

    Acute hypercapneic respiratory failure as evidenced by abnormal

RESULTS

The ten patients were clearly separable into two distinct groups based on changes in sodium and water balances during therapy (Fig 1). Group A (n = 6) exhibited a sustained sodium and water diuresis which began within 24 to 48 hours. Each of the patients in this group lost more than 2 kg of body weight over the six days of observation and treatment. In each case, this weight loss was associated with a cumulative net negative balance for sodium and water in excess of 200 mEq and 2,000 ml,

DISCUSSION

Our studies indicate that the disturbance in sodium and water metabolism associated with acute respiratory failure in patients with COLD is not a single entity. Rather, it can be separated into at least two forms which differ in their response to therapy, as well as in the incidence of severity of underlying hormonal abnormalities. These two forms are not clearly set apart in all their aspects and may, in fact, ultimately prove to be two phases of a pathologic continuum. Nevertheless, their

ACKNOWLEDGMENT

The authors wish to acknowledge with gratitude the technical assistance of Carolyn Magnes and Mary Beth

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  • Cited by (0)

    These studies were supported in part by United States Public Health Service grant HL 14159—the Specialized Center of Research (SCOR) in Hypertension.

    Manuscript received March 14; revision accepted June 29.

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