Vasopressin in the treatment of vasodilatory shock in children.
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.
Masutani
Satoshi
S
Department of Pediatric Cardiology and Cardiovascular Surgery, Saitama Heart Institute, Saitama Medical School Hospital, Saitama, Japan.
Senzaki
Hideaki
H
Ishido
Hirotaka
H
Taketazu
Mio
M
Matsunaga
Tamotsu
T
Kobayashi
Toshiki
T
Sasaki
Nozomu
N
Asano
Haruhiko
H
Kyo
Shunei
S
Yokote
Yuji
Y
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*
D014662:Vasoconstrictor Agents; D014667:Vasopressins