title: Successful treatment with continuous enteral protease inhibitor in a patient with severe septic shock.
abstract: OBJECTIVE
  The mortality rate among patients with septic shock is high despite current therapy. We present a case of Fournier's gangrene and septic shock at 4 years post-heart transplantation that was reversed by "continuous enteral feeding" of the digestive enzyme inhibitor, gabexate mesilate. Recently, powerful pancreatic digestive proteases in the lumen of the intestine have been identified as initiators of the systemic inflammatory response. Intraluminal inhibitions of the proteases significantly attenuates intestinal damage, system inflammation, and multiorgan failure in experimental forms of shock but it has not been tested in man.
  
  
  RESULTS
  Gabexate mesilate, a synthetic digestive protease inhibitor, was continuously administered in two liters of crystalloid solution to a patient by enteral feeding during septic shock. The condition and markers for shock due to sepsis reversed in a few days.
  
  
  CONCLUSIONS
  This case suggested that "enteral" digestive protease inhibition may decrease and even reverse the sequelae of shock and sepsis.
authors.affiliation: Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
authors.forename: Y-T
authors.initials: YT
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Wei
authors.forename: Y-C
authors.initials: YC
authors.lastname: Chuang
authors.forename: C-Y
authors.initials: CY
authors.lastname: Chang
authors.forename: I-C
authors.initials: IC
authors.lastname: Chen
authors.forename: C-F
authors.initials: CF
authors.lastname: Weng
authors.forename: G W
authors.initials: GW
authors.lastname: Schmid-Schönbein
mesh_terms: D000328:Adult; D016027:Heart Transplantation; D006801:Humans; D008875:Middle Aged; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012772:Shock, Septic / Q000188:drug therapy*
chemical_list: D011480:Protease Inhibitors