Very early posttraumatic serum alterations are significantly associated to initial massive RBC substitution, injury severity, multiple organ failure and adverse clinical outcome in multiple injured patients.

BACKGROUND: Multiple severe trauma frequently leads to massive dysbalances of the human immune system. This phenomenon is known as "Systemic Inflammatory Response Syndrome (SIRS)". SIRS is connected to multiple organ failure and thereby entails higher morbidity and mortality in trauma patients. Pro- and anti-inflammatory cytokines such as Il-6, Il-8 and Il-10 seem to play a superior role in the development of SIRS. Several studies support the hypothesis that the very early cytokine release pattern determines the patients' subsequent clinical course. Most data about interleukins in trauma patients however refer to serum concentrations assessed sometime in the first 24h, but there is only little information about release dynamics in a small-meshed time frame in the very initial post-trauma period. PATIENTS AND METHODS: 58 multiple injured patients (Injury Severity Score > 16 points) were included. Blood samples were drawn on patient admission (not later then 90 minutes after trauma) and at 6h, 12h, 24h, 48 h and 72 h. Il-6, Il-8 and Il-10 were measured using an automated chemiluminescence assay (IMMULITE, Siemens Healthcare Diagnostics GmbH). Interleukin levels were correlated to distinct epidemiological and clinical parameters. RESULTS: Interleukin serum concentrations are thoroughly elevated after trauma. Patients with haemorrhagic shock and consecutive massive RBC substitution (n = 27) exhibit higher Il-6, Il-8 and Il-10 levels as compared to patients with minor RBC transfusion extent (n = 31). Interleukin levels also differentiate patients with MOF (n = 43) from such without MOF (n = 15) already at the earliest post trauma time (90 minutes). Il-6, Il-8 and Il-10 concentrations also significantly distinguish patients with adverse outcome (n = 11) from such with favourable outcome (n = 47). Exclusively Il-10 has significant correlation to injury severity (ISS > 35). CONCLUSION: The current study presents an image of the serum Il-6, 8 and 10 releases in multiple trauma patients in the very early post-trauma period. We could thereby demonstrate that interleukin levels can clearly differentiate the presence of hemorrhagic shock and subsequent massive blood product substitution, the development of multiple organ failure and clinical outcome. No significant connection to age, gender and brain injury could be detected. Most importantly, changes in interleukin levels can be observed in the very early posttraumatic phase, at the earliest 90 minutes after trauma.

Functional response of healthy and diseased glomeruli to a large, protein-rich meal.

Differential solute clearances and hormone assays were used to characterize the effect of a large, protein-rich meal (1.5 g/kg) on glomerular function in 12 healthy volunteers (group I) and 12 patients with chronic glomerular disease (group II). Changes from baseline during 3 h after the meal included an elevation of plasma osmolality, progressive urinary concentration, and increasingly positive fluid balance. Plasma renin activity and arginine vasopressin levels (measured in group II only) increased significantly. Nevertheless, the rate of peak postmeal renal plasma flow became elevated by 13 and 33% in groups I and II, respectively. Corresponding peak increases in postmeal glomerular filtration rate exceeded baseline by 10 and 16%. In the proteinuric subjects of group II the fractional clearances of albumin, IgG and uncharged dextrans in the radius interval 36-54 A, declined significantly after the meal. A similar depression of the fractional dextran-clearance profile was observed also in group I. Applying the fractional clearances of relatively permeant dextrans (radii less than or equal to 44 A) to a model of hindered solute transport through an isoporous membrane, we estimate that transmembrane hydraulic pressure difference increased by 12% in group I and by between 0 to 12% in group II after protein ingestion. We conclude (i) that oral protein ingestion increases glomerular ultrafiltration pressure and rate in both normal and diseased glomeruli, (ii) that this hemodynamic response may be mediated in part by the glomerulopressor hormones angiotensin II and arginine vasopressin, and (iii) that the foregoing hemodynamic changes exert no acute adverse effect on glomerular barrier size-selectivity.

Changes in the baroreflex during pregnancy in conscious dogs: heart rate and hormonal responses.

This study was performed to test the hypothesis that reflex increases in heart rate, PRA, and plasma concentrations of vasopressin, angiotensin-II, ACTH, and cortisol are reduced during pregnancy. The hypothesis was tested by measuring, in pregnant and nonpregnant conscious dogs, changes in arterial and atrial pressures, heart rate, and plasma hormone concentrations during 30-min infusions of three doses of nitroprusside (1, 2, and 4 micrograms/kg.min). Between-group differences were determined by comparing the relationships between arterial or atrial pressure and plasma hormone concentrations. Hypotension-induced increases in heart rate and plasma levels of vasopressin, ACTH, and cortisol were blunted when the dogs were pregnant. In contrast, reflex increases in PRA and angiotensin-II were increased. These results indicate that the activity of the baroreceptor reflex is altered during pregnancy in dogs.

Reduction in plasma vasopressin levels of dehydrated rats following acute stress.

The development of a sensitive radioimmunoassay for plasma arginine vasopressin (pAVP) is described. Using this assay, the levels of vasopressin were determined in the plasma of nondehydrated and dehydrated rats after exposure to ether or acceleration stress. Plasma AVP was also determined in rats following nicotine administration. Nondehydrated rats showed no significant changes in pAVP 1, 2, 5, or 15 min after exposure to ether for 1 min. Dehydrated rats, on the other hand, had significantly reduced pAVP after exposure to ether. One group (180-220 g) showed a decline in pAVP of 27% at 2 min (P less than 0.05) and and 47% at 5 min (P less than 0.001) after stress. In a group of larger animals (350-400 g), pAVP levels were reduced by 55% at 1 min (P less than 0.05) and 72% at 2 min (P less than 0.01) after ether stress. A third group (250-300 g) also had significantly reduced pAVP values of 57% (P less than 0.01) 5 min after ether stress but not at 15 min. Nondehydrated rats which were centriguated at -4.1 Gx for 5, 15 or 120 min showed no significant alterations in pAVP. No decrease in pAVP was observed in dehydrated rats centrifugated for 5 min; after 120 min of centrifugation, mean pAVP was reduced by 40% (P less than 0.02) when compared to be noncentrifugated controls. In contrast to either ether or acceleration stress, nicotine provoked a marked rise (P less than 0.005) in pAVP 10 min after injection. From these results it was concluded that ether or acceleration stress does not evoke an increase in the pAVP levels of rats, and furthermore, in dehydrated rats, these stressors will produce a significant decline in pAVP.

Role of endogenous angiotensin II in the control of vasopressin secretion during hypovolemia and hypotension in conscious rabbits.

In order to investigate the physiological role of angiotensin II (ANG II) in the control of vasopressin (VP) secretion, the VP responses to hypotension induced by hemorrhage (20 ml/kg, n = 10) or nitroprusside infusion (1-10 micrograms/kg.min, n = 9) were studied with or without blockade of ANG II formation by the converting enzyme inhibitor captopril in conscious rabbits. Administration of captopril (5 mg/kg, iv) caused a small decrease in mean arterial pressure but did not enhance the hypotensive response to subsequent hemorrhage or nitroprusside infusion. The renin response to both stimuli was enhanced by captopril, whereas the increase in plasma ANG II concentration was attenuated. Plasma VP (PAVP) concentration increased during hemorrhage (2.0 +/- 0.2-113.6 +/- 47.7 pg/ml, P less than 0.01) and nitroprusside infusion (2.1 +/- 0.3-5.1 +/- 1.0 pg/ml, P less than 0.01). Captopril did not change basal plasma PAVP, nor did it attenuate the VP responses to hemorrhage or nitroprusside. Indeed, captopril tended to enhance the VP responses to hemorrhage (2.3 +/- 0.3-147.1 +/- 65.9 pg/ml) and nitroprusside infusion (1.9 +/- 0.2-15.4 +/- 6.0 pg/ml). The relationship between log PAVP and mean arterial pressure during hemorrhage and nitroprusside infusion in the presence of captopril was not different than in the absence of captopril. These results indicate that in conscious rabbits, the renin-angiotensin system does not contribute to the increase in VP secretion during hypotension induced by hemorrhage or nitroprusside infusion.

Potentiation of hormonal responses to hemorrhage and fasting, but not hypoglycemia in conscious adrenalectomized rats.

Bilateral adrenalectomy (ADRX) in rats removes the source of two major stress-responsive hormones, corticosterone and epinephrine. To test how ADRX rats withstand stress, we performed the following experiments in adult male rats provided with indwelling femoral arterial and venous cannulae and either ADRX or sham-adrenalectomized (Sham) 3 days later and given 0.5% NaCl to drink. Five to 6 days after adrenal surgery the rats were studied after either a 15 ml/kg.5 min hemorrhage or after an overnight fast followed by insulin-induced hypoglycemia. In fed unstressed ADRX rats, basal mean arterial blood pressure was slightly decreased; heart rate was increased; blood volume, vasopressin, and oxytocin concentrations were not different from sham values; and renin and norepinephrine were significantly elevated. The recovery of arterial pressure after hemorrhage in the ADRX rats was similar to that in the sham group over a 5-h period; however, the responses of vasopressin and oxytocin were significantly greater, and those of renin and norepinephrine were markedly potentiated in the ADRX group. Heart rate recovered faster in the ADRX group and was elevated, compared to the sham value, for most of the 5-h period. Restitution of blood volume was attenuated in the ADRX group, although the restitution of plasma protein was not different between the groups. A significant difference in the change in plasma osmolality between groups after hemorrhage may account for the attenuated restitution of blood volume. After an overnight fast, which reduced blood volume in both groups of rats, the plasma renin concentration rose still further in ADRX rats; the differences in other measured variables observed between fed ADRX and sham groups remained the same. The insulin-induced 50% decrease in glucose caused minor effects on arterial blood pressure and heart rate and occasioned responses in renin and norepinephrine of similar magnitudes in the two groups. We conclude that in the absence of the adrenals, rats restore arterial pressure after hemorrhage remarkably well through potentiation of the responses of other vasoactive neural and hormonal systems. In these studies the marked potentiation of the renin response suggests that the renin-angiotensin system may be important in the maintenance of arterial blood pressure after reductions in blood volume.

Role of vasopressin in blood pressure regulation during adrenal insufficiency.

The effect of adrenal insufficiency on the plasma concentrations of two vasoactive hormones, vasopressin and angiotensin II, was studied in conscious dogs. In addition the role of vasopressin in the maintenance of blood pressure during adrenal insufficiency was studied using [1-(beta-mercapto-beta, beta-cyclopentamethylenepropionic acid),2-(O-methyl)tyrosine]arginine vasopressin, a specific antagonist of the vasoconstrictor action of vasopressin. Dogs were bilaterally adrenalectomized and maintained on daily cortisol and deoxycorticosterone acetate injections. Withdrawal of steroids for 4 days resulted in a 4-fold increase in plasma vasopressin concentration (P less than 0.05) and a 3-fold increase in plasma angiotensin II concentration (P less than 0.001); mean arterial pressure did not change significantly. Administration of the vasopressin antagonist in adrenalectomized dogs maintained on steroids had no effect on blood pressure. In marked contrast, vasopressin blockade in dogs with adrenal insufficiency decreased mean arterial pressure by 22 +/- 5 mm Hg (P less than 0.001). These results demonstrate the plasma angiotensin II and vasopressin concentrations increase during adrenal insufficiency in conscious dogs, and that vasopressin plays an important role in blood pressure regulation in this hypovolemic state.

Effect of tetradecapeptide renin substrate on blood pressure, plasma renin activity, and vasopressin and adrenocorticotropin concentrations.

The effects of third ventricular injection of tetradecapeptide renin substrate (TDP) and natural renin substrate prepared from dog cerebrospinal fluid were compared in anesthetized dogs. Central injection of 350 pmol TDP caused a long lasting increase in arterial blood pressure, a reduction in PRA, and increases in plasma levels of vasopressin, and ACTH. In marked contrast, central administration of equimolar doses of natural renin substrate had no effect on these variables. Intracranial administration of the converting enzyme inhibitor SQ 20881 prevented the effects of central injection of TDP. Thus, TDP exerts its effects via conversion to angiotensin II and does not necessitate the postulation of the action of an enzyme with renin-like activity in the brain.

Release of vasopressin by angiotensin II.

To test the hypothesis that angiotensin II releases antidiuretic hormone (ADH) after injection into ventricular cerebrospinal fluid, conscious adult male Sprague-Dawley rats with a lateral cerebroventricular cannula received an intraventricular injection of 0, 10, 50, or 100 ng angiotensin II. Trunk blood was collected 90 seconds later for radioimmunoassay of ADH. Plasma ADH, pg/ml (mean plus or minus S. E.), for the four dose levels were 2.8 plus or minus 0.7, 9.6 plus or minus 2.5, 22.6 plus or minus 5.6 and 25.0 plus or minus 5.0, respectively. The increases produced by angiotensin were statistically significant (p smaller than 0.05). Plasma ADH of the 10 ng group was intermediate between control and the two highest angiotensin doses (p smaller than 0.05), suggesting a dose-response relationship. These data provide direct evidence that angiotensin releases ADH by central mechanisms.

Feedback inhibition of adrenocorticotropin and vasopressin responses to hypoxia by physiological increases in endogenous plasma corticosteroids in dogs.

We examined the influence of increases in plasma corticosteroids produced by ACTH infusion on subsequent ACTH and vasopressin (AVP) responses to hypoxia in anesthetized dogs. Basal and stimulated ACTH levels were inhibited by increases in corticosteroids. Moderate increases in corticosteroids (5.2 micrograms/dl) caused a 50% reduction in the subsequent integrated ACTH response to hypoxia. Maximal increases in corticosteroids eliminated the integrated ACTH response to hypoxia. In addition, AVP responses to hypoxia were attenuated by prior maximal elevations in corticosteroids. Physiological elevation of corticosteroids inhibits subsequent ACTH and AVP responses to hypoxia.

Physiological inhibition of ovine fetal plasma renin activity by cortisol.

The purpose of this study was to test the hypothesis that physiological increases in the fetal plasma cortisol concentration after basal and stimulated levels of PRA and vasopressin. Seven fetal sheep, between 121 and 131 days gestation, were infused with cortisol (4 micrograms/min) or vehicle for 5 h. One hour after the end of cortisol or vehicle infusion, sodium nitroprusside was infused into the fetus (100 micrograms/min, iv) to stimulate fetal hormone secretion. Cortisol, but not vehicle, infusion increased the fetal plasma cortisol concentration and decreased fetal PRA, but did not alter the fetal plasma vasopressin concentration. Cortisol-infused fetuses responded to nitroprusside with slightly smaller PRA responses but with equal vasopressin responses compared to those of vehicle-infused controls. Fetal blood pressure was not affected by either cortisol or vehicle infusion. Nitroprusside caused a slightly greater reduction in pressure in fetuses receiving cortisol infusion compared to those receiving the vehicle. We conclude that physiological increases in fetal plasma cortisol decrease fetal PRA without altering the fetal plasma vasopressin concentration. The results suggest that repeated fetal stress might produce progressive reduction of fetal PRA activity and might, therefore, alter cardiovascular homeostasis.

Lesions of the organum vasculosum of the lamina terminalis (OVLT) attenuate osmotically-induced drinking and vasopressin secretion in the dog.

Drinking and secretion of arginine vasopressin (AVP) in response to intravenous infusion of hypertonic NaCl were studied in dogs before and after destruction of the OVLT. The functional relationship between plasma osmolality and plasma AVP was eliminated following destruction of the OVLT. Furthermore, osmotically-induced drinking was significantly reduced in dogs with OVLT lesions. These data are compatible with the hypothesis that the OVLT contains osmoreceptors in the dog.

Effects of carotid occlusion and angiotensin II on vasopressin secretion in intact and vagotomized conscious rabbits.

Experiments were performed in conscious rabbits with sectioned aortic depressor nerves to determine whether there is an interaction between angiotensin II (Ang II) and the baroreceptor reflexes in the control of arginine vasopressin (AVP) secretion. Baroreceptor reflexes were activated by a 5- or 10-min period of bilateral carotid occlusion with or without background infusion of Ang II at 10 or 20 ng/kg.min. Carotid occlusion increased mean arterial pressure, right atrial pressure, and heart rate, but did not change plasma AVP (PAVP) concentration. Infusion of Ang II at 10 ng/kg.min increased PAVP from 4.0 +/- 0.9 to 6.3 +/- 1.8 pg/ml (P less than 0.05). Carotid occlusion during Ang II infusion produced the same cardiovascular changes as before Ang II, but still failed to increase PAVP. Because increased atrial pressure can inhibit AVP secretion, the experiments were repeated in acutely vagotomized rabbits. Vagotomy increased heart rate but did not change mean arterial pressure or PAVP. Carotid occlusion after vagotomy increased PAVP from 2.2 +/- 0.2 to 3.3 +/- 0.5 pg/ml (P less than 0.05). Ang II infusion again increased PAVP but did not enhance the AVP response to carotid occlusion (2.9 +/- 0.4 to 3.9 +/- 0.7 pg/ml). These results provide further evidence for a role of the carotid sinus baroreceptors and vagal afferents in the control of AVP secretion and demonstrate that Ang II stimulates AVP secretion in rabbits. However, they do not reveal any interaction between Ang II and the baroreceptor reflexes in the control of AVP secretion.

Effect of baroreceptor denervation on the inhibition of renin release by vasopressin.

Previous studies have suggested that the inhibition of renin secretion by acute administration of vasopressin in conscious dogs results from a reflex reduction in renal nerve activity. In the present investigation, this hypothesis was tested by studying the effect of total baroreceptor denervation or selective low pressure baroreceptor denervation on the suppression of PRA by vasopressin in conscious, chronically prepared dogs. In eight sham-operated dogs, a 45-min infusion of vasopressin (2.0 ng/kg.min, iv) decreased PRA from 10.5 +/- 1.9 to 5.9 +/- 1.0 ng/ml.3 h (P less than 0.01). Mean arterial pressure did not change (110 +/- 10 to 107 +/- 7 mm Hg), but heart rate decreased from 84 +/- 9 to 69 +/- 8 beats/min (P less than 0.05). In contrast, vasopressin infusion failed to significantly decrease PRA in seven sinoaortic/cardiac denervated dogs (9.5 +/- 1.7 to 7.4 +/- 2.0 ng/ml.3 h), although decreases did occur in three of the dogs. Mean arterial pressure increased from 104 +/- 5 to 125 +/- 6 mm Hg (P less than 0.01), but heart rate did not change (112 +/- 4 to 107 +/- 5 beats/min). When renal perfusion pressure was maintained at the preinfusion level in three sinoaortic/cardiac denervated dogs, vasopressin infusion failed to decrease PRA (2.3 +/- 0.6 to 2.4 +/- 0.6 ng/ml.3 h). In six cardiac denervated dogs, vasopressin infusion decreased PRA from 5.3 to 0.9 to 3.1 +/- 0.7 ng/ml.3 h (P less than 0.01). Results obtained with two lower doses of vasopressin (0.5 and 1.0 ng/kg.min) were generally similar to the responses observed during infusion at 2.0 ng/kg.min. Angiotensin II (5.0 ng/kg.min) suppressed PRA in all groups of dogs. These experiments demonstrate that the inhibition of renin secretion by acute administration of vasopressin in conscious dogs is prevented by total baroreceptor denervation, but not by denervation of the low pressure baroreceptors alone. These results suggest that the suppression of renin release by vasopressin is a reflex response resulting from activation of the high pressure baroreceptors.

Evidence that the effects of isoproterenol on water intake and vasopressin secretion are mediated by angiotensin.

The effect of isoproterenol (6 microgram/kg sc) on drinking, urine flow, and vasopressin secretion was examined in a group of trained dogs with chronically implanted third ventricular cannulae. Isoproterenol stimulated drinking in association with a reduction in urine flow and an increase in urine to plasma osmolality ratio. Plasma renin activity increased from 3.1 +/- 0.8 to 13.0 +/- 2.7 ng/ml/3 h and plasma vasopressin concentration increased from 11.3 +/- 1.3 to 40.3 +/- 12.5 pg/ml. The effect of isoproterenol was reexamined during an intracerebroventricular infusion of the angiotensin II antagonist, saralasin (0.02 microgram/kg/min). This treatment did not affect the isoproterenol-induced increase in plasma renin activity, but inhibited the drinking, antidiuresis, and increase in plasma vasopressin concentration. These data indicate that the effects of isoproterenol on drinking, urine flow, and vasopressin secretion are mediated via the renin-angiotensin system.

Effects of increases in plasma vasopressin concentration on plasma renin activity, blood pressure, heart rate, and plasma corticosteroid concentration in conscious dogs.

It is known that vasopressin decreases PRA and heart rate and increases blood pressure and plasma corticosteroid concentration. The purpose of this study was to determine the plasma concentration of vasopressin required to produce these effects. Arginine vasopressin was administered iv to five normal conscious dogs as priming injections of 0.1, 0.5, 1.0, 2.5, 5.0, and 10.0 ng/kg, followed by infusions of 0.01, 0.05, 0.1, 0.25, 0.5, and 1.0 ng/kg x min, respectively, for 30 min. These doses produced increases in the plasma vasopressin concentration (+/- SE) of 1.0 +/- 0.8, 2.1 +/- 4.3, 4.3 +/- 1.8, 11.4 +/- 1.0, 19.7 +/- 6.4, and 30.8 +/- 7.8 pg/ml, respectively, from a basal level of 2.7 +/- 0.2 pg/ml. An increase in the plasma vasopressin concentration of 2.1 +/- 0.3 pg/ml suppressed PRA by 19 +/- 5% (P < 0.02); increases of 4.2 +/- 1.8 pg/ml or more suppressed PRA by 34 +/- 12% (P < 0.005). Only the highest dose of vasopressin produced a significant pressor effect (9 +/- 3 mm Hg; P < 0.05) or lowered the heart rate (18 +/- 4 beats/min; P < 0.005). An increase in plasma vasopressin concentration of 19.7 +/- 6.4 pg/ml was required to increase the plasma corticosteroid concentration (1.2 +/- 0.2 to 2.2 +/- 0.4 microgram/dl; P < 0.01); the largest dose of vasopressin increased the plasma corticosteroid concentration from 1.5 +/- 0.1 to 2.4 +/- 0.6 microgram/dl (P < 0.02). Twenty-four-hour water deprivation in the same dogs increased the plasma vasopressin concentration from 2.5 +/- 0.2 to 7.4 +/- 0.6 pg/ml (P < 0.01). Nonhypotensive hemorrhage in another group of dogs increased the plasma vasopressin concentration from 2.5 +/- 0.2 to 47.4 +/- 16.8 pg/ml (P < 0.05). These data indicate that elevations in the plasma vasopressin concentration within the range observed during 24 h of water deprivation and nonhypotensive hemorrhage produced significant decreases in renin secretion and heart rate and elevations in blood pressure and corticosteroid secretion.

Suppression of vasopressin secretion by clonidine: effect of alpha-adrenoceptor antagonists.

Studies were performed in anesthetized dogs to determine if the diuretic effect of clonidine results from inhibition of vasopressin secretion. Intravenous clonidine (30 microgram/kg) decreased plasma vasopressin concentration (as measured by RIA) from 10.9 +/- 1.5 to 5.0 +/- 1.1 ng/ml (P less than 0.01) in association with a transient increase in arterial blood pressure and a decrease in heart rate. Intravenous administration of two alpha-adrenoceptor antagonists, piperoxane and phentolamine, virtually abolished the pressor effect of clonidine but did not prevent the suppression of plasma vasopressin concentration. Clonidine decreased plasma vasopressin concentration from 11.9 +/- 3.1 to 3.3 +/- 1.0 pg/ml in the phentolamine-treated dogs (P less than 0.01) and from 18.1 +/- 4.5 to 12.4 +/- 3.6 pg/ml in the piperoxane-treated dogs (P less than 0.05). These results provide direct evidence that the diuretic effect of clonidine results from inhibition of the secretion of vasopressin. This inhibition does not appear to be a consequence of the pressor effect of the drug but may result from a direct action in the central nervous system.

Apparent dissociation of adrenocorticotropin and corticosteroid responses to 15 ml/kg hemorrhage in conscious dogs.

The blood pressure, heart rate, ACTH, corticosteroid, vasopressin, and renin responses to rapid 15 ml/kg hemorrhage were measured in six conscious healthy dogs with chronically maintained femoral arterial catheters. The hemorrhage decreased the mean arterial blood pressure slightly (P less than 0.001), increased the heart rate (P less than 0.001), and increased arterial plasma levels of ACTH (P less than 0.01), corticosteroids (P less than 0.001), vasopressin (P less than 0.001), and renin activity (P less than 0.001). Overall and in the individual experiments, there appeared to be little correspondence between the ACTH and corticosteroid responses. In none of the experiments was there a clear rise in ACTH above control levels before the first rise in corticosteroids. To ascertain that adrenal secretion of corticosteroids was increased during 15 ml/kg hypovolemia, changes in the clearance and distribution volume of cortisol were estimated by counting tritium extracted from plasma of five dogs infused with [1,2-3H] cortisol to steady state levels before and during hypovolemia. The stimulus caused a 30% reduction from steady state levels of dichloromethane-extractable tritium counts (P less than 0.001). Combined with the observed increase in plasma corticosteroid levels, these results show that the increase in adrenal secretion of corticosteroids after hemorrhage was underestimated by measurement of changes in peripheral plasma levels. The hypothesis that hemorrhage results in an increase in adrenal sensitivity to ACTH is tested in the following paper.

Insulin-induced hypoglycemia in conscious dogs. I. Dose-related pituitary and adrenal responses.

We have measured changes in plasma glucose, ACTH, corticosteroids, and vasopressin and hematocrit after five doses of insulin in six conscious dogs. We found insulin dose-related changes for each of these responses (P less than 0.01, by two-way analysis of variance). The increases in plasma ACTH and hematocrit correlated to the decrease in plasma glucose; the increase in plasma vasopressin was more strongly correlated with the increases in plasma Na+ than with the decreases in plasma glucose. Each dog appeared to have a characteristic ACTH response curve; therefore, the relationship between plasma glucose and plasma ACTH responses varied among dogs, but was significant in five of six dogs studied. Maximal plasma corticosteroid responses occurred with submaximal plasma ACTH responses (200-600 pg/ml). A single dose of insulin produced reproducible changes in plasma ACTH when given to five dogs in three separate experiments over a 2- to 6-month period. In these experiments, the measurement of ACTH allowed us to distinguish three levels of response to insulin, whereas measurement of the corticosteroid response allowed us to distinguish only two levels of response.

Corticosterone, but not glucose, treatment enables fasted adrenalectomized rats to survive moderate hemorrhage.

Fed adrenalectomized rats survive the stress of hemorrhage and hypovolemia, whereas fasted adrenalectomized rats become hypotensive and hypoglycemic after the first 90 min and die within 4 h. We have studied the effects of glucose and corticosterone (B) infusions after hemorrhage as well as treatment with B at the time of adrenalectomy on the capacity of chronically prepared, conscious, fasted, adrenalectomized rats to survive hemorrhage. We have also measured the magnitudes of vasoactive hormone responses to hemorrhage. Maintenance of plasma glucose concentrations did not sustain life; however, treatment of rats at the time of adrenalectomy with B allowed 100% survival, and acute treatment of adrenalectomized rats at the time of hemorrhage allowed about 50% survival during the 5-h posthemorrhage observation period. Rats in the acute B infusion group that died exhibited significantly increased plasma B and significantly decreased plasma glucose concentrations by 2 h compared to the rats that lived. Plasma vasopressin, renin, and norepinephrine responses to hemorrhage were markedly augmented in the adrenalectomized rats not treated with B, and plasma vasopressin concentrations were significantly elevated at 1 and 2 h in all of the rats that subsequently died compared to values in those that lived. We conclude that: 1) death after hemorrhage in fasted adrenalectomized rats is not a result of lack of glucose; 2) chronic and, to an extent, acute treatment of fasted adrenalectomized rats with B enables survival; 3) fasted adrenalectomized rats exhibit strong evidence of hepatic insufficiency which is not apparent in either fed adrenalectomized rats or B-treated fasted adrenalectomized rats; 4) death after hemorrhage in fasted adrenalectomized rats may result from hepatic failure as a consequence of marked splanchnic vasoconstriction mediated by the actions of extraordinarily high levels of vasoactive hormones after hemorrhage; and 5) B appears to act to decrease the magnitude of response of vasoactive hormones after hemorrhage in fasted adrenalectomized rats.