Arginine vasopressin in vasodilatory shock: effects on metabolism and beyond.
OBJECTIVE
To describe the effects of arginine vasopressin other than its vasoconstrictive and antidiuretic potential in vasodilatory shock.


RESULTS
Arginine vasopressin influences substrate metabolism by stimulation of hepatic glucose release, gluconeogenesis, ureogenesis and fatty acid esterification. Although arginine vasopressin is a secretagogue of different hormones, only prolactin increases during arginine vasopressin therapy. Plasmatic and cellular coagulation are affected by arginine vasopressin, resulting in thrombocyte aggregation. Therefore, platelet count typically decreases following arginine vasopressin infusion in critically ill patients. In addition, arginine vasopressin reduces bile flow and may increase bilirubin concentrations. Despite its potential to decrease serum sodium, no change in electrolytes was observed in critically ill patients receiving arginine vasopressin. Although arginine vasopressin is an endogenous antipyretic, body temperature is not decreased by central venous arginine vasopressin infusion. In addition, arginine vasopressin modulates immune function through V1 receptors. Compared with norepinephrine, arginine vasopressin may have protective effects on endothelial function. Net arginine vasopressin effects on gastrointestinal motility seem to be inhibitory and are dose dependent.


CONCLUSIONS
Except for its antidiuretic and vasoconstrictive actions, the effects of arginine vasopressin in patients with vasodilatory shock have so far only been partially examined. Potential influences of arginine vasopressin on metabolism and immune, liver and mitochondrial function remain to be assessed in future studies.
Dünser
Martin W
MW
Department of Intensive Care Medicine, Inselspital Bern, Bern, Switzerland. martin.duenser@i-med.ac.at
Westphal
Martin
M
D000818:Animals; D001127:Arginine Vasopressin / Q000494:pharmacology / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D001833:Body Temperature Regulation / Q000187:drug effects; D004703:Endocrine System / Q000187:drug effects; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000502:physiology; D010085:Oxidative Phosphorylation / Q000187:drug effects; D012769:Shock / Q000188:drug therapy* / Q000378:metabolism; D014664:Vasodilation
D001127:Arginine Vasopressin