Orthostatic fluid-electrolyte and endocrine responses in fainters and nonfainters

The responses to orthostasis of fluid-electrolyte and endocrine indicators in persons subject and not subject to fainting during tilting are investigated, along with the effects of heat acclimatization and physical training on those responses. Plasma volume and electrolytes and plasma vasopressin and renin activity were determined in tilt-table tests conducted before and after an eight-day period of daily heat acclimation during exercise at 50% maximal oxygen uptake at 40 C, or a control period of exercise at 24 C. Half of the 10 subjects in the study, regardless of exercise regime, showed improved orthostatic reactions in the second tilting test, related to increases in post-tilt plasma volume and potassium concentration, particularly in the nonfainters. In the first test, plasma renin activity is observed to increase fivefold and plasma vasopressin 50 times after the transition from the supine to the orthostatic positions; the respective increases were reduced by 50 and 75% in the second test. The fainters also exhibit a greater increase in vasopressin and a lower increase in renin activity upon tilting than the nonfainters. Results indicate the orthostatic-induced vasopressin increase to be related to volume control independent of renin activity.