KKU. Vet. J. Vol. 16 No.2 May - August 2006 37

Vasopressin I

Vasopressinl

cl 6) 9rl u6l 9)?l'l { [ 6t o n llln'l T [[ Il ['u il'l ? u u ? ht u u Ft I Ft ta

tlfleuu Fnl'l gl0fi'ufi

Alternative Drug for Cardiopulmonary Arrest

rTrfl eri.:rru-

Patchanee Sringam

nlr;u-':tquuetei'uuorl4qorarulovTufi rflunrryinqoroianrrrfir.lfiifl rflarfionrrr.-r X

t oo &q

t - "3

d d a ai j : u a^tTl.t}ll\lJ?'100:'ln']::00T?o11.111.[FlutLnvfla?a'1illn Q.]Nn-]:flnulttrtor0rntru0q:rnr::o9lT'tql

otnnttve-.tnairr rloorluurfitd'un*ltnr:yir.:ruro.:ra-'llo:-]oounrealortv{fruduainrry:ln66oqsi .q.^' ra a A Lq r ev ^ v a aepinephrine q{ilr[utilil:J5rurn*lnaonaanarnHiLo rrsinr:[riursl,tn6irirnqzun{r.]L€lu.t flo

-i q e A q e X u q o q eL q e d ^ Y atillJnl:[T00nTtauLl-inn''rtJ[1.iot4'] [ottnrrr LuHr Lotoutirzueo.]ury o.:uu vasopressirr 6.luilud d a iu, oqe d o

dnufrlrr.ttdonfr"Lrivir"Lvirffozundr.:t6u{e*tndirr Ieu vasopressin vfrlv{rffon'i:uoqiradr.rrrn

to.:unao;fiooue,.tlurdorfiovTrir.:nru fizunrfinriouqionr:Hereiito.lunoorfioouo{'lufl-xlouoyvl 'Vi ,d a 6t - Y a ju , a-'Lq urqi'tilffzunqianr:uoo?lO.runoornoq[ro.]Luflero.r o*.:riurjtHrrui6oofi"lljrfiu.rarorrrn;u-']lqA;XQ.l [ililflit

,', u1l1:[] ,

firrtfovfinr:6n:*rrrnrururfiotv{nr:ud'hnr:vfr.:rutarvi:to rJoo rrnyalo.:tv{f,u

6uainTrrJn6 (cardiopulmonary cerebral resuscitation; CPCR) tan-tnll:u-ltoraqoroi'urint- 6r u d , , yaHUel14'lu"[ovlufr (cardiopulmonary arrest; CPA) iroiri.:vwiroqr:rnr::oq6iqei']uln?t-.tluyl't.l

nlrttv\rfttnr#flrtrilnri lXass and Haskins, 1992; Wingfield and Van Pett, 1992; Bauew,

1997; Willmcs et al., 2002) Ios"[uvrr.:n1ril?'rvrdfi#qrtntrrsofiiqil:rsJril s-1s% eiruriorunlU

?1'1.1fln?ttllvtunu'Lrjrurn odr.:'[:frq']e,r Wingfield and Van Pelt (1992) Ttu.l'tu'j'lfqiln'trraqldAo@o-AdoT?fltuqt,tl 4.1% Luttru1 9.6% arnflurrrnsrril?frflnl?r CPA o"ruru 169 srfruny s2 dtqq

u.'A- n'rfll1r6r:T?yru1 nrurflqtrL?{ytufl'tflqi ruurrnurnulauuriu a.tiLa.t o.toutrriu 40002

Department of Physiology, Faculty of Veterinary Medicine, Khon Kaen University, Khon Kaen, 40002

q

3B x'r:dr:dYn?rrl\yran'tdFli sJ?. flfi to qriufi 2 ylqunlnil - firnrnt zs+g

c.ifl'lsJo'loiu

"lulruvfr Kass and Haskins (1992) wujrfqr:rnr::oo6iotuq#1 g% 'luuurur

q

2.3% fitu#'itfi.rt14er?o.r cPA ovrrqnqirrriu:vH'ir.:nuriu#o{Iouvru'irtuouo:fioriuqrJ'rotnqq

qrrretfiorJnGto.:uoocrtfioouorluu-rlo e'rutu#q{ni'lulrnufiorornoxrilfiqilnGro{n#rrrdo

vYrtorrorn-nrfioitrurilra-rlorauoroiu (asystole) nrrru-r'[ov{o.roir.rrsiuin (ventricutar fibrillation)4

ttflsT1\aTuUotsll{ (pulseless electrical activity) (Ballew, 1997; Waldrop et al., 2004)\4 a d a Lo

rrqiadrr'L:fforlo5:ivrurllO.:n1:rfifi cPA oruafioun-r.itueruun;#o{ qirriunr:finu'rnt:d'qn1r

cpntusrulolnr:'[d'n-o{ileno{ 6.rlvidoernfirijurj:rlurfiLrnyr"rtunr.rnr:unrrfunr#qruilnda

rjnfinr:vir cPCR Hn-.:nrrv CPA oril:rnoroi'lu g liuqau6o nr:d'lu6iqrrdord'uA Fr , q eA 6l d 4 a& , da Y A <, Yry.3tUun]:T'luLuLnonl:u'luL0ltfl::rL]-JHrJl{t'iuuteioeoru n't:T'ru6lqnuarBrtiluluotou61 6l- A 4 6l , da v d^ A *[unlTLTU'Ittfl3tFr:0.1il0tun]TTlUd1n ttnrnt:qttnum.:TooTlo,rr epinephrine iiluurnoniqo ^

t

ilLTLun't:vl't CPCR rrtflutrnrn'ir +o iJ rfiatornlunrry cpA a;rffqntr?u'tuei'torir.lrurn4 d A A ^ oqea alJ0.:Hd0oL00grttgr.M^lTtvn']:frvfleJt0.t1J0.tLfluttflvR-t?tL1-t0tu0t1q0onrLau ?1'tLvtrf5etrr*tnoql

tr.tritrfiorfiaoir.:1 Iqutailr:aro.ruovvirlodqn{ oirriuirrnru6.rfine'lnnlraoufl1{0.rleunr:"i --^

un-.: endogenous epinephrine LLflr norepinephrine virlv{finoqrifiootrq.tyt'ri'l.tfi'tufiftQi'?A 1 - d 14 r av - i . - , - q -i g - Y a o 6l et1l0 LH[a0o Liltnil.]0?u?vvtaternttufr]J0.tLLnrH? L0ttatrulju o,:uu epineohrine 6.lnnureLr [t'

5ld"lulurgd (Swenson and Reece, 1993; Ganong, 2001; Cao et al., 2003)'lunr:vir CPCR

u#rnrry CpA

a{ o d 6l t ( v 6t , jq -iloauiuornnr:frn:grLud'qrironorvruurer:?"LHrifi'Lvir..rnGtunrrr cpA 6a vasopressin1 -i r dt d, & 6l e,rLqutreJa'lnnlTFllill1Jtuil '1996 ir:vol vasopressin g.:luatrn[up.i:-l'lu CPCR nnrrnonr':rCPA (Lindner et al., 1996a) oi.lrfu6.lfinr:ilqna.rtd'vasopressin rijuar:rfirusrmileriufiorrfiil4 vl ra" * X uq a A a j

t6oo'[rJrfiu.rnd'rrurfiorai'l'Loitovsruo.:n:rfl cpn rfiora6nrfiu.]r.tnrfruo''lnnr:l"i'epinephrine

dt American Heart Association (2000) 6'o vasopressin rfJxurfiarlr:nldrrnu epinephrine5f d u q v t v

^ , u Vl ,u dl erl e d u 6t I q d stunrilnl?314? 10fi0{ot.ltouinttsru.:'LtL:u:4.: Lli[rfn:rxn': [qiluottc{urun: Lu{ilrlufrn Lquo]-gl

lti vasopressin o{tu:;eiu class ttn oirraiu epinephrine nno-qodlu class indeterminate, ql -r.'.-r'.'..._ ti q

1on:rtfi t; eirraiutuyn.:#a'tLtv,tl4ricote et at. (2003) urusdrtri'l#vasopressin Lry1l{ epinephrineq d u6l v | tu

^ L6l e Lq u v

^ d v[un:rxnrr;u1[ol{otei].rta''*3n vr1lofiuerei'u n-'r'Lorqiud'rfiqilndunrfrilaruuerrd'u (n1ilfi 1 )

4-- a q u 6' dr " A, X, qe q

frnr:dn:*rlufqimeno':tiJuo'rurururnfi:-i.:fi'jrnr:'Ld vasopressin lunr:vir cpcR tri'zundr 0e

n?ln.1TLT epinephrine (Krismer et al., 2000; Wenzel et al., 2000; Wenzel and Lindner,

2001 ) et-.ltiu:Jnnlrufid.rfi1e4iuilrutfi0d1tfll.[ou?ru'rnrla{ vasopressin tunr:vir cpcRqc)u ar*.r n I ? r c pR rfi a rfl udo ru n air H iu nr:rir l rtd'[unr.: n fi fi n qi o'lil,t'l

KKU. Vet. J. Vol. 16 No.2 May - August 2006 39

o 1 :1 0 fi 1 u fi o { nr rs-q :r riur o.: rr n fi rr ui o ur fi "["fr'[u nr :rir u 6i qi rius,r{

Srou o101noq11N

^t^^^ Ivtdbb I

Class lla

Class llb

Class lll

Class indeterminate

uiu;rirlvY[d'uvr:r rfiunin oiuariu euuir flil::RrBnrn unrn rreJ:J n oe]fru ars9g

r o aL irt ritdtei yr :r r fi ll n-n o r u a rir a uu i r fi rl : v R r t n r n r n r fl 'r'') il ! a a q R-Er@9

r a rirtrald'toirn:r:flv #norunfi auurrfi:l:yR nfin'ril rLf,yq ?'r:Jiln aon-u*9

LNN%8EJ

U , o a d e U ,d , , n e a[il L 0tu::l Llt LTrl {:-13 L:.iulJ:3fry]Dn't}\ t.ilv0'tQn 0 L1|tno0%fl:r El

ndodLU,d,€UUo?\E 111 [O t1 :133JilflnfiIUu1-5lJ1"?'l LtuL1ll-t01+O:-lLtLqn teJ [OhilO

14EJ'l: American Heart Association, 2000

nlilfi t usqrliuaoulr.lnrrrLri'hrfiorfiqnr?ril-xtod'o.lsir.rroiu3n fi-rtqrauerieiu v{':toroi'u"i'rc

fi e:l n 6 unyfr il o:u u e reiu luyn.r #qr uy{ yl Liq

YIEJ,.l: Cole et al., 2003

epinephrine riluurfitd'[unl:yfr CPCR loru epinepnrine n:r{'uvir cx,-adrenergicq

o6lereceptor ttnr B-adrenergic receptor dr^*n'lrnr:q'u{i cl-adrenergic receptor qryir'ldfiooe

q

t6oquer'i6iru:Jnruuoo-r rfluzuolr.i'rfioen#ucilirlorfirudu rrwfinr:n:yqiu p-adrenergic

receptor ortfisJffglrn'rrtei'ull0.rfirtottnvor1ilttr.rlilnl:fir-Loi'rto.rnd'reLrfi'ora-rto virtv{rflerv d iu 'a , ra ! qe q e X u6l ,qra uq

Hn1l.ltfiu.t11 [3.J1\.]11:yfr.to Fl0tililn]T[T00nfltouLLnyiln{{11.tLuna1ilt1aan? [o na LmtnoH? Lo

,ry

Ventricular fi brillation@ Defibrillate - Deliver 2-5 Jlkg (external),

0.5-l J/kg (internal)- Provide up to 3 consecutive shocks.

@ Resume chest compressions- Continue for 60?90 seconds.

@ Drug therapy: Epinephrine (0.01-0.1 mg/kg IV)

orVasopressin (0.8 u/kg IV)

: Lidocaine (2 mg/kg IV)or

: Amiodarone (5-10 mg/kg I\|@ Repeat defibrillation (2 X initial energy).

As1.-stole/Bradvcardi a/pulseless electrical activitl'@ Drug therapy

: Atropine (0.04 mg/kg IV)Lor.ver dose, if palpable pulse

or suspected vagal arrest.

: Epinephrine (0.0f -0.1 mg/kg IV)- May repeat ai 3? 5 minute intervals.

Vasopressin (0.8 u/kg IV)- Civen one time only.

@ Consider transthoracic pacing- Must be instituted early

v d A v v & u6l vt, ; & Yqtq|1,[tT?il9t0.]14?3 nfl1il[1.[0fi'][0 LeJr1.:1U ttfleUnq lactate t1^13.J1J1 ?1.]LU1Jn[3n1Tyt'tltflrflnn

40 xl:flr:#nxul\ruFlldni sJ?. flfi to arirfi 2 y,rquarnxJ - R.rurnr zs+g

nr:vi'r CPCR (Ditchey and Lindenfeld, 1988) , rnrlndnr:tfepinephrine tu CpCn u-.1fiYo,Ariaornquotuoti't.t tdu n:rflnr:vfr CPCR rilurroruru n1:eloilfllro.:?o.t c{,-adrenergic

receptor oia epinephrine qsoqn.ttdrorlno'lrrriJun:e (Willmcs et at., 2002; Johnson, 2003)

utnl epinephrine fteirqrd.l6isr#u:J::rLrru 2040 iurfi 6.roio.r"[v{#ranruq,5"o 1s*un.on and Reece,

1993; Ganong, 2001) tturiofrr'.tu.:ru'ir trirryuer':rruuqnqir.r:yll'irrnr:ld epinephrine

llll'lelLJ'lororu#:ilurqfin.rrfiorr-liurrfiruriu placebo (Woodhouse et al., 1995) 6.:frnr:4_-.- j' y A Aa %dfi n r*'t €l uo ?t ty{ a nt u't ?t ru n ruat u qi o n i I e pi n e p h ri n e

,d.....A:..,,

QYIS llliltJ,llll O$, vasopressin

vasop ress i n riJ u uJ rj'[n ri'a o ih ufr zu fi olutah] vr r n r rTa u frr urlil r ff ut{fi qr o :Ltqisl o.lf i ad 4 F d q

R?1.{?1''lu nl:ufl.l1a.l vasopressin nnfl1Ln}J Loloao[eLnrnolo.:tnoorrottJitrnrt6ao LuunoeaAai radaA&o6-u6oe fr{rfroooeilnr66rlo.rrfr0ertfrtJfruornnirf,loil osmorecepiorstu'lahJnrorar-sud":n:yoi'u

qq' ;- ;4 j F n

on6l a L r11414fl.: vasopressin ttrylflu ttnvtilo:-l5rurn+r6oo"Luunaorfioenon.ro:nniuflou baroreceptor

firao oqrfi oo ttq.ttfinjttosra-rtofioruu drnr:*r*oto.:#ryrurruern baroreceptor virtrifinrruf.Jtv

4vasopresstn ty't 3J1J1-[

tln1Jo.3 vasopressin qiounoorfiao Lfiootnnr:n:r{'uta.t vasopressin- specific V1q

A * ! a a ..6]-?.a a ,L .receptornnR'l&Jt1.[otruutle.]u0ootnoe vlrLdtfronr:uoo':odr.ltrnfloJunoqtfroot[o.]?.1?Tt{ri,'tu

*qifizunrfinriouqiantrfiqrel-xr0.:unoo16aorror'lura*rtounr'[q] truti'o'l*ifiunqionr:unqr-.lro.JHfl0errfioqttq.ltuarua.l oit#u6trfiru:l3annrr6oqlilrfi'u.tfltro.t (Hatdane and Marks, 2002;

Cao et al., 2003) vasopressin qrfiqirnd.:fiiqril:ylrru 10-15 urfi drurun.ir epinephrineX .- rl *l s& d T q vu0no1nu vasopressin fl'ttJtrn [li'Lr,[rrrrrunoerhoq n:ronr[ntunoo0u [eu'[d'turo

eql

tvirnuvi.r 3 il'l.l (Wenzel and Lindner,2001; Johnson, 2003) Ieutus#TrrnrLril?111.nqdo 6l c^ra

ltl.tvl,t1"L]i'[d 6o 0.8 U/kg rdrrr.:Hooorfiaq (Cote et at., 2003)

eiruzuolor vasopressin qionr:riuflgfl'r?v tfiqotnnr:n:rqiuro.t v2 renal receptorA 'q & o q ea 4--.-1 _.- ! , 5q vr -l Avl0 u Ll.lru[uqnnl1jo{'Lqorvir [u'tfrqntrtn0ot,lfrT a.rur ilruzutl.l tflan tufl?u? o.]yto Ln:1ru n^latlud a U - . X o q ey d ra d T o< j X a.i3Jn-lrelelutlulna:Jillnru nrLli:laarrsil:lSilriloqnlurnyfioonLeLnr66rffrufiu n:ruflTretvasopressin tliu nrrtT:ntl16o (diabetes insipidus) zuritrqn6i"[ueirulo.:yiatfl:rilosh]uosJq uY ! itH1{1tflnOuvtil'tu (Swenson and Reece, 1993; Guyton and Hall,2000; Ganong, 2001)

KKU. Vet. J. Vol. 16 No.2 May - August 2006

619' onl: tS vasopressin [U CPCR

arnn'rr#{tnoqir.htra#rn'rlv cPA tv{riornfi'uorufiur'lrJanr:6ruoi'utd'vasopressin,uqi4ql

Iqu Lindner et al. (1996a)1oi'6nr*reiriru CPA o'ruru O0 nu wlnnrt#tLl(uf,rfi.llrn::u'jr.r:rer:u vasopressin fig.rniu:rlluquuiuurfioonflrryir.:ru'[oira.r (return of spontaneousilq

circulation; ROSC) dlel:.ttilalirln-u epinephrine Tou epinephrine fis.:ostrinrrt#rufi'ufr8rnuqio ROSC

nr:6n r*rtu#q {r o n o { d1 }t? l.uJr n il u'j r nr:ld' vasopressi n tv{2 o 6 I q u r ailr r o rir.: 8.:

n:rfl nr:vir cPcR tiJ utr nr uruurn;lv{zu n 6 n'lr epinephrine Hr ntud'rul otrJSilr r*rfi o q fi'[rJri.:n-rtqun:flilo.l (Krismer et a1.,2000; Wenzel et a|.,2000; Wenzel and Lindner,2001)

nr:6n:+'tu?tu't?t1lo.t vasopressin airumno:td'an: unslulqto.t vasopressin fitd'lu#q{q

nonato$:luir.r o.+-o.B u/kg rdunr:finurtusn: cpA o"ruru t7 er-r iluir an:neirufi1d'iuq9qt ' , av--

vasopressin (n=6) :oo6iqr tru:fiqn:nsilfi'lqii:t epinephrine (n=6) rrdr saline placebott .l(n=5) otuyt".tliiler[flolornfi:oul:nluaror airuqn:fitd'iu vasopressin hiyrr:ouI:qrnr.r

A*esilo.ltiloel:?qfloLo'?il magnetic resonance imaging rrqilnrln':rrufio:Jn6rfiu.lrfinriouda nr:

o e f vr,,?1'1"111.t1JO{nnl?.Jtuo [aLillsarunu (mild ataxia) (Wenzel et al., 2000) etlu Kr-ismer et al.

(2000) dnr*rlunn:nrtr cPA fivir cpcn rflurrnrurunu'jrnn:nsirfi'lriYl vasopressin9q

nrrur:ninr+r:se;LqtrsJeiurorunootfiaqrie{tuu-?ioloi'rvirriuutolrnnir 1s mmHg anoer49 a A , Aul-* vteaTiusl?nl?'l?11nlTfln191 ?[wrqn:nnilYj[orL epinephrine fl'uJtrnin]gr:lfruai'.ln6irr'lqirfrur

L YX - t q

T-?etlrl vt-'tfierlrrtoiuro.:Hnoqr6oqrrottufirtorurnn'jr 15 mmHg fioriJusirr-irdrrr noscnlrfin:*rnr:tdvasopressin rr.:orfffinn-upirhu cpA fiyir cpcR riJuirnruru ilu.j'lq,

na-.101n1d'vasopressin luluro 40 u fi''lrJ'r:nylitv{qirJrudru?u B nil frt*ri'otour (LindnerqJ

et al., 1996b) rfior:JSuurfiuuriu'jt{nr:tf vasopressin rrnr epinephrine ylu'jrn'trroofiiqt

frufi low '[u uasopressin ti:-r 3s% tu epinephrine rrflsntrroerfiiqnrEJlu z+ d',lh.r ooz6l-A?"[u

vasopressin nTu 20%Iu epinephrine (Lindner et at., 1997) uonorndfr:ru.:runtrdntglu:J3ll rfi ulnlrtd vasopressin tu#:Jr u cpR unvtu#fl{yrqno.lilu'jrtuerunr:ld'vasopressin"[r.{'zundrvirn-l

epinephrine ei':uluao{vrq0o.w\L'jrnr:'[dvasopressin1fi2n6n'jryr&.: epinephrine

ttnr placebo (Biondi-Zoccai et al., 2003) orir{'l:fferlfi:rlnu'jT'lrjnusrlrrurrqnei.t.Jto.]LdAan:rnr::oqfrin (stieil et at., 2ao1) unv Rosc (it'uri', 2s4g) tur.iilrt:;m.jr.lnr:td

vasopressin L[og epinephrine

41

42 ?'rrdlrd'nxr1\nerFlrdrri il?. fld t6 auTnfi 2 nqunrneJ - fitlnnt zs+g

vasopressi n rfi atd'[unll v cpA virtfiH n o ol rfi o q rro.r 6i'] uil nr ru o qt-": riiuzu otrdlfi o o

'[r.Ju-rrartorrn;:vuuil:rarreirunnrru',nd* ti'.:fit.t,fitorn:roirnr:uqal-?T0.r14oaotfiootto.ri, u anflluq_'r.:61 10.{T1.tn1uq0Lfl1.t0.3910 vasopressin ttqnql.lnu tT1.[ :3qunl:u9]o'lljo.iunooLnao

q a u e X ovlr a q uq Vl

tLo,tLuu?fiu.: nnrrutuonru nr[a rurnn?']n'tr14qlsr1fl0{un0otn0oLto.t[u14xto Lqr ttflrRil0.]dqe4oqea6lu6t-Xrn,.l0.1[14ufltfrtJo1Ail't L14un0q[fl09ttto.: Ll.[fix LattnrfrSJ0.lfto'tuo'] 1{0na'lnu vasopressin L3.Jtllil

q t a 4 - X v q U , o q eu q v d ^ a a Ynr:Ltooncit0ulunnrrtiiau? L0rrn: Lrunr Luue [0toutrlpJoa{il'];tfitJ0u epinephrine :?3J11.:

vasopressin ottvie.rndmnn:rflnr:yir CPCR riJuirnrururl\msrrrql0ufluo.Jta{ V1 receptorsA-,61 <r

Fl.t ?1 Ltu 0 u Lunl?r HJunT9t{zu ndr r rd u.: fi n utunr :td' vasooress i n 6 o rJ o q u r il u'.t #u u^, fft*tu firh u u n-.r or n'[v{nr.:

ql

A v a'Lq d q qe uq Y. Xflfl00tn00 nnl3Jtu014't [Qljretnoo 11.[fr1.[1mqno{fln{a-rn LuYt1.114? La T?3J?1.1o'la}lu[1.{oo'luLlfl3

rJfrfi3urnr:uvi 1Lonnson, 2003) oirriutuvrr.:rJfrri6oi"ru#srrunyttinr?rt4finrdrrnr:"lv{

v a s o p re s s i n yn.r u*': t o r fi o fl o.: nTu r.r n rir.: r 6 u r e-r n Fi r r

Itr:il..q

u X ou r6te , X, dle qe dq-rn{otntiLo.tqrlAtLnvnt:fl't:'tan'r:1.nLilLTil't.ton1.lnL.tT?'tn't:Ltvasopressin [uzungra

a i.qv a t i <'nirnr:t'i'epinephrine rr{:'ts vasopressin fiqvrfrvir'lv{ranoot6ooLto.:ai'luilortuqeir 6.tiflu

daodleavlr*XoqXXr1,.6leL6lvudoFl0Yt'1[14tfl091 Lilflils.]rLovnfl'l&Jruafi? LaSJ.lnlju u0ilatnu vasopressln ltj?1-l L14141Latqud ^ - r:r, -l qe a 6l u & q6l & a i

t:?'.l9r0.1fi')sttfl3 LeJtuliln'rTLTacnSto14LunnliltuaH? [0 :?tJ?1.] vasopressin ilzuntilx.JFr'rlj0.3

^ i' A & aa ' A X v a9t?LtLTUn1UT1.[OY]U.tU0nn1:tl^tlJlJUlJ0.tn]Tt09rT?O tTU t't:ty{}JlJU1O{Fr?-t3J9tU14fl09rtfl09rtt9r.l

tura-elo nr:rfiruduro.:rj3rurr*rfi0efililrfi'urflilo.r unryirtf:vuuHliuriuurfioon#uurvir.:ruvl e e & \1 d &q 6 v d v e a !t9lto.lt:?11,[ u0aul.:'Lrfiq1s.Jfi'.]'[unl{nlTtLlt?uJttflvfi9?ttl{?1u u.l9lo.]flnu'lt1^{}JLqiltunr:ri't

vasopressin'[:Jld'yrr.:efiflntunr:vir cPcR yn-rnrrv cpn Iquiarryrslu#o.:to.:zuodr.r16u.:Aquoqile

rfi o"Lrdsr rr:n ut vasopressi n eLr"L#Loi'o dr.: il n a q n-ufi ae

. i:.91 A' : 1oflff1501{0$

,

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