Hemodilution therapy

In patients at risk for focal cerebral ischemia, hemodilu-tion has been proposed as a prophylactic and resuscita-tive therapy to ameliorate brain injury. The rationale for hemodilution therapy is based on two facts 1) blood viscosity decreases when blood is diluted with many crystalloid and colloid solutions and 2) an inverse... 

This case is typical of many others. In six patients with cerebral circulatory disturbances who received hemodilution therapy for 9-10 days with etherified starches (molecular weight 200 kDa and a high degree of substitution, 0.62), all the multimers of von Willebrand factor fell to the same extent. This corresponds to type 1 von... 

Wolfe S, Arend O, Bertram B, et al. Hemodilution therapy in central retinal vein occlusion. One-year results of a prospective randomized study. Graefes Arch Clin Exp Ophthalmol 1994 232 33-39. 

Pioglitazone also causes fluid retention, possibly because of increased production of vascular endothelial growth factor (92). The safety profile of monotherapy and combined therapy with pioglitazone has been evaluated in 3500 patients over 2500 patient-years, and some data from post-marketing surveillance were included peripheral edema and hemodilution were common (93). 

For subarachnoid hemorrhage surgical clipping of the causative aneurysm or resection of the arteriovenous malformation is the mainstay of treatment. Endovascular coiling of the aneurysm can also be performed. Post-operative infection (either brain or respiratory) is an uncommon complication and not believed to be any more common than after other invasive surgical procedures. Hypervolemic-hemodilution and hypertensive (HHH) therapy is used to prevent spasm. There may be a role for anti-inflammatory measures for the prevention of vasospasm and delayed cerebral ischemia, as shown in a recent pilot study of patients treated with statins (Lynch et al., 2005). 

The autonomous, sustained production of AVP in the absence of known stimuli for its release is called SIADH. In this syndrome, plasma AVP concentrations are inappropriately increased relative to a low plasma osmolality and to a normal or increased plasma volume. SIADH may be the result of one of several factors production of vasopressin by a malignancy (such as a small cell carcinoma of the lung), the presence of acute and chronic diseases of the central nervous system, pulmonary disorders, or a side effect of certain drug therapies. In addition, as many as 10% of patients undergoing pituitary surgery have a transient SIADH approximately 8 to 9 days after surgery (when the patient is at home), which responds to water restriction (2 to 3 days) and resolves without recurrence. In SIADH, a primary excess of AVP, coupled with unrestricted fluid intake, promotes increased reabsorption of free water by the kidney. The result is a decreased urine volume and an increased urine sodium concentration and urine osmolality. As a consequence of water retention, these patients become modestly volume expanded. The increase in intravascular volume causes hemodilution accompanied by dilutional hyponatremia and a low plasma osmolality. Volume expan-... 

AT activity continued to dechne in the placebo group due to continued consumption and hemodilution, despite 2 units of FFP not providing adequate AT replacement therapy. 

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