Effect of dopexamine on hepatic metabolic activity in patients with septic shock.
Hepato-splanchnic metabolic activity is seen to be related to regional blood flow and oxygen/substrate availability in patients with sepsis. Catecholamines, which may modulate metabolic activity perse, are common to stabilize hemodynamics. We studied the effect of a dopexamine-induced increase in splanchnic blood flow (Qspl) on regional metabolic rate in 10 patients with septic shock requiring norepinephrine to maintain mean arterial pressure (>60 mmHg). Splanchnic blood flow was determined using the indocyanine-green method with hepatic venous sampling. We determined the hepato-splanchnic lactate, pyruvate, alanine, and glutamine turnover and the lactate/pyruvate and ketone body ratio as well as the endogenous glucose production (EGP) using the stable isotope approach. Qspl increased from 0.86 (0.79-1.15) to 0.96 (0.92-1.33) L/min/m2, not influencing any parameter of metabolic activity. We speculate that this finding is due to altered beta-adrenoreceptor-mediated thermogenic effects due to the interplay of different beta-sympathomimetics at the receptor site.
Kiefer
P
P
Department of Anesthesiology, University Clinic Ulm, Germany.
Tugtekin
I
I
Wiedeck
H
H
Vogt
J
J
Wachter
U
U
Bracht
H
H
Geldner
G
G
Georgieff
M
M
Radermacher
P
P
D000328:Adult; D000368:Aged; D000409:Alanine / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D004298:Dopamine / Q000031:analogs & derivatives / Q000494:pharmacology* / Q000627:therapeutic use*; D005260:Female; D005947:Glucose / Q000378:metabolism; D018698:Glutamic Acid / Q000378:metabolism; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007657:Ketone Bodies / Q000378:metabolism; D007773:Lactates / Q000378:metabolism; D008099:Liver / Q000098:blood supply / Q000187:drug effects / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000187:drug effects; D011773:Pyruvates / Q000378:metabolism; D012039:Regional Blood Flow / Q000187:drug effects; D012772:Shock, Septic / Q000188:drug therapy* / Q000378:metabolism* / Q000503:physiopathology; D013152:Splanchnic Circulation / Q000187:drug effects; D014665:Vasodilator Agents / Q000494:pharmacology* / Q000627:therapeutic use
D007657:Ketone Bodies; D007773:Lactates; D011773:Pyruvates; D014665:Vasodilator Agents; C046318:dopexamine; D018698:Glutamic Acid; D005947:Glucose; D000409:Alanine; D010100:Oxygen; D004298:Dopamine; D009638:Norepinephrine