L-arginine: nitric oxide pathway in endotoxemia and human septic shock.
OBJECTIVE
To investigate the relationship between nitric oxide production, endotoxemia, and hemodynamic alterations in human septic shock.


METHODS
Prospective study.


METHODS
A 32-bed intensive care unit in a university referral hospital.


METHODS
Two groups of septic patients with shock (n = 13) or without shock (n = 16) and an additional group of nonseptic patients as control group (n = 25).


METHODS
Plasma nitrite and nitrate concentrations were measured as an index of nitric oxide generation. Nitrite and nitrate concentrations were correlated with plasma endotoxin and hemodynamic variables.


RESULTS
Increased plasma nitrite and nitrate concentrations were found in patients with septic shock (p < .01). Nitrite and nitrate correlated directly with endotoxin concentration (r2 = .21, p < .05) and cardiac output (r2 = .49, p < .05), and inversely with systolic blood pressure (r2 = .24, p < .01).


CONCLUSIONS
This study demonstrated the activation of the L-arginine:nitric oxide pathway in human endotoxemic septic shock, suggesting that nitric oxide may be an important mediator of the hemodynamic disturbances in this pathophysiologic situation.
Gómez-Jiménez
J
J
Critical Care Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain.
Salgado
A
A
Mourelle
M
M
Martín
M C
MC
Segura
R M
RM
Peracaula
R
R
Moncada
S
S
D001120:Arginine / Q000097:blood*; D002302:Cardiac Output; D003404:Creatinine / Q000097:blood; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D009566:Nitrates / Q000097:blood; D009569:Nitric Oxide / Q000097:blood*; D009573:Nitrites / Q000097:blood; D012772:Shock, Septic / Q000097:blood* / Q000503:physiopathology
D004731:Endotoxins; D009566:Nitrates; D009573:Nitrites; D009569:Nitric Oxide; D001120:Arginine; D003404:Creatinine