EFFECTS OF HYPERTONIC-HYPERONCOTIC INFUSION ON THE HUMAN ATRIAL-NATRIURETIC-FACTOR IN A STANDARDIZED CLINICAL-TRIAL

Hypertonic-hyperoncotic solutions (HHT) are presently being utilized t o resuscitate patients in shock. However, so far, the effects of HHT o n human atrial natriuretic factor (hANF) have not yet been investigate d in a clinical trial. The effects of HHT on hANF were studied in a st andardized preoperative and clinical setting in patients undergoing an eurysmectomy. Twenty-three conscious patients were included in two gro ups: 11 HHT and 12 HES (HHT: 7.5% NaCl/10% HES 200; HES:.9% NaCl/10% H ES 200). Stepwise infusion of 50 mt was titrated preoperatively accord ing to individual Frank-Starling relationships. Central venous pressur e (CVP) and pulmonary capillary wedge pressure (PCWP) were determined before, during and after volume application. hANF, cGMP were also meas ured before and 1, 10, 30, 60, and 120 min after administration. The v olumes necessary to produce the same volume status were: 213.6 +/- 63. 6 mL of HHT, 409.9 +/- 136.2 mL of HES (p < .001). The sodium load was 273.9 +/- 81.5 mmol of [HHT], 63.1 +/- 21.0 mmol of [HES] (p < .001). The data before and after volume loading were: PCWP: 7.9 +/- 3.9 to 1 4.9 +/- 4.3 mmHg of [HHT], 7.9 +/- 5.2 to 14.5 +/- 4.3 mmHg of [HES] ( p < .001); CVP: 3.5 +/- 2.3 to 6.9 +/- 2.9 mmHg of [HHT], 3.3 +/- 3.1 to 7.5 +/- 3.2 mmHg of [HES] (p < .001); hANF: 42.5 +/- 11.7 to 81.6 /- 30.8 pg/mL [HHT] (p < .01), 42.0 +/- 11.2 to 74.1 +/- 47.6 pg/mL [H ES] (p < .05); cGMP: 4.4 +/- 1.2 to 10.5 +/- 4.2 nM [HHT] (p < .01), 4 .9 +/- 1.7 to 12.6 +/- 5.8 nM [HES] (p < .001). The changes in CVP and PCWP were identical after infusion of HHT or HES in normovolemic pati ents. The increased hANF levels produced by identical atrial dilation with different dosages. Furthermore, plasma-hANF excretion was due to an acute volume expansion of the right atrium. Acute sodium load had n o effects on hANF excretion.