Abstract
The relationship of intravascular volume depletion (IVVD) to hemodynamics and renal failure in Reye syndrome (RS) was studied in three comatose children managed with mannitol osmotherapy (dosage total 7 ± 0.7 gm/kg) without barbiturate loading. Common hemodynamic parameters proved insensitive indicators of IVVD, remaining elevated (CVP 8 ±2 torr, PWP 10 ± 2 torr, MAP 109 ± 30 torr, CI 3.2 ± 0.9 1/min/m2) despite microcardia, reduced stroke index (25 ± 8 ml/beat/m2), and intense peripheral vasoconstriction (SVR 33 ± 7 units). Nonoliguric renal failure (hourly output 2.7 ± 1.2 ml/kg) developed in 2 of 3 cases (peak BUN 50 ± 2 mg/dl and peak creatinine 3.3 ± 0.5 mg/dl). Peak serum osmolality was 337 ± 6 mOsm/1. Systemic vasoconstriction responded to volume expansion on 6 occasions (5% albumin 11 ± 6 ml/kg) with a 38% decrease (P=0.005) in SVR (20.5 ± 2 units) and a 41% increase (P=0.047) in stroke index (35 ± 12 ml/beat/m2). Filling pressures rose slightly (CVP 10 ± 2 torr, PWP 11 ± 3 torr), MAP fell slightly (92 ± 11 torr), and CI rose (P=0.010) by 28% (4.1 ± 0.7 1/min/m2). Fluid challenge effects were transient but diagnostic. Renal failure resolved with liberalized fluid intake. The data suggest that a vasoconstrictive response to IVVD may cause a redistribution of renal blood flow and play a role in the development of renal failure in RS.
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Mickell, J., Berman, W., Ward, J. et al. 171 HEMODYNAMIC BASIS FOR RENAL FAILURE IN REYE SYNDROME. Pediatr Res 15 (Suppl 4), 468 (1981). https://doi.org/10.1203/00006450-198104001-00180
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DOI: https://doi.org/10.1203/00006450-198104001-00180