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British Medical Bulletin 41:212-217 (1985)
© 1985 The British Council

research-article

FLUID AND ELECTROLYTE DISTUBANCES AFTER TRAUMA: THE ROLE OF ADRENOCORTICAL AND PITUITARY HORMONES

L P Le Quesne, J P S Cochrane and N R Fieldman

Department of Surgical Studies The Middlesex Hospital Medical School London

Abstract

During and after a surgical operation, there is an inevitable and essential increased secretion of cortisol, lasting some 24 h after an operation of average severity. There is also an inevitable, short-lived (approximately 6 h) increased secretion of aldosterone, more prolonged in the presence of hypovolaemia. The increased output of aldosterone is stimulated by an increased secretion of renin, and that of cortisol by ACTH. The postoperatie impairment of sodium excretion is not primarily caused by the icreased output of cortisol or aldosterone.

During and after operation, there is an increased secretion of arginine vasopressin (AVP), varying in its pattern and duration, and rising to levels far in excess of the maximum antidiuretic level. During the period of raised plasma AVP levels, the urinary output is almost invariably hyperosmolar and its volume is determined by the solute load. Following the fall AVP to normal levels, a diuresis with free water clearance is usually, but not invariably, seen.


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