III. Physiology: ADH Related Water Regulation Mechanisms

  1. See Sodium and Water Homeostasis
  2. Antidiuretic Hormone (ADH or Arginine Vasopressin) overall effect is to increase renal water reaborption
  3. ADH is released from the posterior pituitary
    1. Released in response to osmoreceptors in the hypothothalamus detecting hypertonicity
    2. Hypertonicity also stimulates thirst sensation
  4. Response to increased plasma osmolality (and increased plasma Sodium concentration, Hypernatremia)
    1. Increased ADH secretion
    2. Water retention by the Kidneys
    3. Decreased plasma Sodium concentration (and decreased plasma osmolality)
  5. Response to decreased plasma osmolality (and decreased plasma Sodium concentration, Hyponatremia)
    1. Decreased ADH secretion
    2. Free water diuresis
    3. Increased plasma Sodium concentration (and increased plasma osmolality)
  6. Direct Sympathetic System effects to increase Blood Pressure
    1. See Blood Pressure Physiology
    2. Antidiuretic Hormone (Vasopressin) increases Vasoconstriction and Peripheral Vascular Resistance
  7. Abnormal Antidiuretic Hormone
    1. Syndrome Inappropriate ADH Secretion (SIADH)
      1. Inappropriate ADH release, resulting in water retention despite normal Sodium and water status
      2. Results in Isovolemic Hypoosmolar Hyponatremia
    2. Diabetes Insipidus
      1. Excessive constant water diuresis due lack of pituitary ADH release or lack of renal response
      2. Nephrogenic Diabetes Insipidus
      3. Central Diabetes Insipidus

IV. Mechanism: Vasopressin

  1. Receptor Activity
    1. Exclusively at Vasopressin receptors (some on vasculature)
  2. Effects
    1. Increases Systemic Vascular Resistance while still maintaining CNS and cardiac Blood Flow
    2. Effective, even in severe acidosis

V. Dosing: Adults

  1. Diabetes Insipidus
    1. Vasopressin 5-10 units IM or SQ twice daily to four times daily
  2. Cardiac Arrest (Prior ACLS guidelines)
    1. Vasopressin 40 units IV once (second dose may be given after 3 minutes if if first ineffective)
    2. Per older guidelines, Vasopressin 40 units IV once was given instead of Epinephrine 1 mg every 3-5 min
  3. Septic Shock
    1. Vasopressin Infusion: 0.01 to 0.04 units/min (up to 0.1 units/min have been used)
  4. Bleeding Esophageal Varices
    1. Vasopressin 0.2 to 0.4 units/min (up to max of 0.8 units/min - very high dose)

VI. Adverse Effects

  1. Higher doses may be associated with Myocardial Ischemia
  2. Hyponatremia (and water Intoxication)
  3. Tissue necrosis on extravasation
  4. Gastrointestinal distress (Abdominal cramping, Nausea, Vomiting, Flatulence)
  5. Headache
  6. Sweating

VII. References

  1. (2020) Tarascon Pharmacopeia, accessed 12/28/2020

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Related Studies

Ontology: Argipressin (C0003779)

Definition (MSH) The predominant form of mammalian antidiuretic hormone. It is a nonapeptide containing an ARGININE at residue 8 and two disulfide-linked cysteines at residues of 1 and 6. Arg-vasopressin is used to treat DIABETES INSIPIDUS or to improve vasomotor tone and BLOOD PRESSURE.
Definition (NCI) This protein is processed from a precursor protein consisting of arginine vasopressin and two associated proteins, neurophysin II and a glycopeptide, copeptin. Arginine vasopressin is a posterior pituitary hormone which is synthesized in the supraoptic nucleus and paraventricular nucleus of the hypothalamus. Along with its carrier protein, neurophysin II, it is packaged into neurosecretory vesicles and transported axonally to the nerve endings in the neurohypophysis where it is either stored or secreted into the bloodstream. It has a direct antidiuretic action on the kidney, and also causes vasoconstriction of the peripheral vessels. This hormone can contract smooth muscle during parturition and lactation. It is also involved in cognition, tolerance, adaptation and complex sexual and maternal behaviour, as well as in the regulation of water excretion and cardiovascular functions. (LocusLink)
Definition (CSP) usual mammalian antidiuretic hormone, it is a cyclic peptide with arginine in position 8 of the chain.
Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH D001127
SnomedCT 420773001, 421078009, 77671006, 418097000
English Vasopressin, Arginine, Argipressin (product), Argipressin (substance), Arginine Vasopressin, Arg Vasopressin, Arg-Vasopressin, Cys-Tyr-Phe-Gln-Asn-Cys-Pro-Arg-Gly-NH2, cyclic 1-6 disulfide, Arginine Vasopressin [Chemical/Ingredient], arginine vasopressin, ARGIPRESSIN, argipressin, AVP - Arginine vasopressin, Arginine vasopressin, DDAVP - Arginine vasopressin, Argipressin, Vasopressin, ADH, AVP, Antidiuretic Hormone, Arginine vasopressor (substance), Arginine vasopressor
Spanish arginina vasopresina (sustancia), arginina vasopresina, argipresina, argipresina (producto), argipresina (sustancia), Arginina Vasopresina, Argipresina, Arg-Vasopresina
Portuguese Arginina Vasopressina, Argipressina, Arginina-Vasopressina, Arg-Vasopressina
Russian АРГИНИН-ВАЗОПРЕССИН, АРГИПРЕССИН, ARGIPRESSIN, VAZOPRESSIN, ARGININ, ARGININ-VAZOPRESSIN, ВАЗОПРЕССИН, АРГИНИН
Italian Arginina vasopressina, Argipressina, Arg-vasopressina
French Arg-vasopressine, Argipressine, Arginine vasopressine, Arginine-8 vasopressine
Swedish Argininvasopressin
Finnish Argipressiini
Czech argipresin, arginin vasopresin
Japanese アルギニンバゾプレッシン, アルギプレシン, アルジプレッシン, バソプレッシン(AVP), バソプレシン-アルギニン, バソプレシン(AVP), アルギニンバソプレシン, アルギニン-バソプレシン
Croatian ARGIPRESIN
Polish Argininowazopresyna, Argipresyna, Wazopresyna argininowa
Norwegian Arginin vasopressin, Argipressin
German Argininvasopressin, Argipressin, Vasopressin, Arginin-

Ontology: Vasopressins (C0042413)

Definition (MSH) Antidiuretic hormones released by the NEUROHYPOPHYSIS of all vertebrates (structure varies with species) to regulate water balance and OSMOLARITY. In general, vasopressin is a nonapeptide consisting of a six-amino-acid ring with a cysteine 1 to cysteine 6 disulfide bridge or an octapeptide containing a CYSTINE. All mammals have arginine vasopressin except the pig with a lysine at position 8. Vasopressin, a vasoconstrictor, acts on the KIDNEY COLLECTING DUCTS to increase water reabsorption, increase blood volume and blood pressure.
Concepts Amino Acid, Peptide, or Protein (T116) , Hormone (T125) , Pharmacologic Substance (T121)
MSH D014667
English Antidiuretic Hormones, beta Hypophamine, beta-Hypophamine, Vasopressins, Vasopressins [Chemical/Ingredient], adh vasopressin, antidiuretic hormone, ADH, adhs, antidiuretic hormones, vasopressin (ADH), vasopressin
French Hormones antidiurétiques, ADH (Antidiurétic hormones), Bêta hypophamine, Hormones anti-diurétiques, Beta hypophamine, Beta-hypophamine, Bêta-hypophamine, Vasopressines
Swedish Vasopressiner
Czech vasopresiny, antidiuretické hormony
Finnish Antidiureettiset hormonit
Italian Ormoni antidiuretici, Beta-ipofamina, Vasopressine
Russian ANTIDIURETICHESKIE GORMONY, BETA-GIPOFAMIN, VAZOPRESSINY, АНТИДИУРЕТИЧЕСКИЕ ГОРМОНЫ, БЕТА-ГИПОФАМИН, ВАЗОПРЕССИНЫ
Japanese 抗利尿ホルモン, バソプレシン, ベータハイポファミン, バソプレッシン, バゾプレシン
Croatian VAZOPRESINI
Polish ADH, Hormon antydiuretyczny, Wazopresyny
Norwegian Antidiuretisk hormon, Vasopressin, ADH
Spanish Pitresina, betahipofamina, Vasopresinas, Hormonas Antidiuréticas
Portuguese Pitresina, beta Hipofamina, Hormônio Antidiurético, Vasopressinas
German Antidiuretische Hormone, Beta-Hypophamin, Vasopressine