(Circulation. 1997;95:1122-1125.)
© 1997 American Heart Association, Inc.
Articles |
Vasopressin Deficiency Contributes to the Vasodilation of Septic Shock
the Departments of Medicine (D.W.L., H.R.L., E.M.G., S.S., J.A.O.) and Surgery (D.D., M.C.O.), Columbia University, College of Physicians & Surgeons, New York, NY, and the Department of Surgery (R.C.A.), Allegheny General Hospital, Pittsburgh, Pa.
Correspondence to Donald W. Landry, MD, PhD, Columbia University, Department of Medicine, 630 W 168th St, New York, NY 10032.
Background The hypotension of septic shock is due to systemic vasodilation. On the basis of a clinical observation, we investigated the possibility that a deficiency in vasopressin contributes to the vasodilation of septic shock.
Methods and Results In 19 patients with vasodilatory septic shock (systolic arterial pressure [SAP] of 92±2 mm Hg [mean±SE], cardiac output [CO] of 6.8±0.7 L/min) who were receiving catecholamines, plasma vasopressin averaged 3.1±1.0 pg/mL. In 12 patients with cardiogenic shock (SAP, 99±7 mm Hg; CO, 3.5±0.9 L/min) who were also receiving catecholamines, it averaged 22.7±2.2 pg/mL (P<.001). A constant infusion of exogenous vasopressin to 2 patients with septic shock resulted in the expected plasma concentration, indicating that catabolism of vasopressin is not increased in this condition. Although vasopressin is a weak pressor in normal subjects, its administration at 0.04 U/min to 10 patients with septic shock who were receiving catecholamines increased arterial pressure (systolic/diastolic) from 92/52 to 146/66 mm Hg (P<.001/P<.05) due to peripheral vasoconstriction (systemic vascular resistance increased from 644 to 1187 dyne·s/cm5; P<.001). Furthermore, in 6 patients with septic shock who were receiving vasopressin as the sole pressor, vasopressin withdrawal resulted in hypotension (SAP, 83±3 mm Hg), and vasopressin administration at 0.01 U/min, which resulted in a plasma concentration (
30 pg/mL) expected for the level of hypotension, increased SAP from 83 to 115 mm Hg (P<.01).
Conclusions Vasopressin plasma levels are inappropriately low in vasodilatory shock, most likely because of impaired baroreflex-mediated secretion. The deficiency in vasopressin contributes to the hypotension of vasodilatory septic shock.
Key Words: shock • hypotension • vasodilation
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|
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|
|
|
|
 |
|
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|
|
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
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|
|
|
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|
|
|
|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
J. A. M. Avontuur, F. Boomsma, A. H. van den Meiracker, F. H. de Jong, and H. A. Bruining Endothelin-1 and Blood Pressure After Inhibition of Nitric Oxide Synthesis in Human Septic Shock Circulation, January 19, 1999; 99(2): 271 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Buijk, H. A. Bruining, J. A. Oliver, and D. W. Landry Vasopressin Deficiency Contributes to the Vasodilation of Septic Shock • Response Circulation, July 14, 1998; 98(2): 187 - 187. [Full Text] [PDF]
|
|
|
|
 |
|
 Vasopressin and Septic Shock Journal Watch Cardiology, April 28, 1997; 1997(428): 14 - 14. [Full Text]
|
|
|
|
|
|
I. A. Reid Role of Vasopressin Deficiency in the Vasodilation of Septic Shock Circulation, March 4, 1997; 95(5): 1108 - 1110. [Full Text]
|
|
|
|
 |
|
 M. Bucher, J. Hobbhahn, K. Taeger, and A. Kurtz Cytokine-mediated downregulation of vasopressin V1A receptors during acute endotoxemia in rats Am J Physiol Regulatory Integrative Comp Physiol, April 1, 2002; 282(4): R979 - R984. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K.-L. Laugwitz, H.-J. Weig, A. Moretti, E. Hoffmann, P. Ueblacker, I. Pragst, K. Rosport, A. Schomig, and M. Ungerer Gene Transfer of Heterologous G Protein-Coupled Receptors to Cardiomyocytes : Differential Effects on Contractility Circ. Res., April 13, 2001; 88(7): 688 - 695. [Abstract] [Full Text] [PDF]
|
|