title: Vasopressin in the treatment of vasodilatory shock in children.
abstract: BACKGROUND
  Many recent studies suggest that vasopressin deficiency is an important cause of catecholamine-resistant hypotension with vasodilation in adults, but little is known about vasopressin deficiency in children.
  
  
  METHODS
  To clarify the usefulness of vasopressin administration in pediatric cathecolamine-resistant hypotension with preserved ventricular contractility, urinary output and blood pressure response to vasopressin were retrospectively analyzed in 12 consecutive patients (15 instances) who were treated with vasopressin. The causes of vasodilation were central nervous system disturbance (n = 5), side-effect of drug (n = 5), and infection (n = 5). Plasma vasopressin concentration was measured six times before vasopressin administration and five times during vasopressin administration.
  
  
  RESULTS
  Patients were divided into four groups according to their response to vasopressin administration. In group 1 (n = 5), urinary output increased to > 3 mL/kg per h within 3 h after vasopressin administration. In group 2 (n = 4), urinary output increased to > 3 mL/kg per h from 3 to 5 h after vasopressin administration. In group 3 (n = 4), urinary output did not increase to > 3 mL/kg per min within 5 h after vasopressin administration, but systolic blood pressure increased to > 120% of the level at the time of vasopressin administration. All remaining patients were classified into group 4 (n = 3). Plasma vasopressin concentration were low considering the markedly hypotensive state in all six instances. Plasma vasopressin concentration during vasopressin administration were significantly increased compared with before administration (P < 0.05). No apparent side-effects were observed in this series.
  
  
  CONCLUSIONS
  Vasopressin deficiency may occur in catecholamine-resistant hypotension of pediatric patients due to various causes including central nervous system disturbance, drug induced hypotension and sepsis. Small doses of vasopressin administration seems to be very effective in such conditions by increasing blood pressure and urinary output.
authors.affiliation: Department of Pediatric Cardiology and Cardiovascular Surgery, Saitama Heart Institute, Saitama Medical School Hospital, Saitama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Masutani
authors.forename: Hideaki
authors.initials: H
authors.lastname: Senzaki
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ishido
authors.forename: Mio
authors.initials: M
authors.lastname: Taketazu
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Matsunaga
authors.forename: Toshiki
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Nozomu
authors.initials: N
authors.lastname: Sasaki
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Asano
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yokote
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014556:Urine; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000097:blood / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins