PEDIATRICS Vol. 83 No. 5 May 1989, pp. 700-705
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Vasopressin Levels and Pediatric Head Trauma

Guadalupe Padilla MD1, John A. Leake 1, Robert Castro MD1, M. Gore Ervin PhD1, Michael G. Ross MD1, and Rosemary D. Leake MD1

1 The Departments of Pediatrics and Obstetrics, University of California Los Angeles School of Medicine, Harbor-UCLA Medical Center, Torrance, California

The syndrome of inappropriate secretion of antidiuretic hormone is associated with head trauma; however, there are no reports concerning vasopressin levels in pediatric patients with head trauma. Urine vasopressin in eight children (mean ± SEM, age 7.5 ± 1.6 years, range 1 to 15 years) was measured by radio-immunoassay during their hospitalization for head trauma. Urine vasopressin values for ten healthy children (mean age 5.4 ± 1.3 years) and for eight children hospitalized for systemic antibiotic treatment of infections (age 5.9 ± 1.8 years) also were obtained. Urine vasopressin, urine and serum sodium concentration and osmolality, urea nitrogen, creatinine, and fluid intake were measured within 24 hours of admission and daily for the following two days. For the first three days following head trauma, mean urine vasopressin levels in pediatric patients with head trauma were increased (P < .05) compared with those of healthy children. Despite fluid restriction to 85% of maintenance level, 25% of patients with head trauma exhibited the clinical syndrome of inappropriate secretion of antidiuretic hormone (hyponatremia, increased urinary sodium, diminished serum osmolality, and urine osmolality greater than serum osmolality). Urine osmolality greater than 800 mosm/kg was associated with markedly increased urine vasopressin levels (200 to 1,650 pg/mL); children with this finding may be at particular risk for the syndrome of inappropriate secretion of antidiuretic hormone without restrictive water intake.

Key Words: vasopressin • head trauma • water balance • hyponatremia • inappropriate secretion of antidiuretic hormone syndrome

Submitted on February 9, 1988
Accepted on June 30, 1988




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