title: [Septic shock. Update of treatment using hypertonic saline and antidiuretic hormone-vasopressin].
abstract: Safety in the use of small volumes of hypertonic saline solution for hypovolaemic shock and in the treatment of intracranial hypertension has been demonstrated in studies in the field of resuscitation. There is little experience of this for septic shock in humans. Beneficial immunomodulatory effects have been detected in pre-clinical studies. Interactions with the pituitary-adrenal axis and with the secretion of anti-diuretic hormone are varied and suggestive, but are not sufficiently understood. On the other hand, vasopressin has cardiovascular, osmoregulatory, and coagulation effects, and also acts on the hypothalamic-pituitary-adrenal axis. There is a relative deficit of vasopressin in septic shock. Its use in these patients does not seem to have any advantages as regards mortality, but may be beneficial in patients at risk from acute renal failure, or those who receive corticosteroids. Terlipressin is a vasopressin analogue that has also been studied. The synergy between vasopressin and hypertonic saline is a hypothesis that is mainly supported in pre-clinical studies. The use of hypertonic saline solution in septic shock, although promising, is still experimental, and must be restricted to the field of controlled clinical trials.
authors: Unidad de Reanimación Postquirúrgica, Hospital General de Ciudad Real, Ciudad Real, España.
authors: J
authors: J
authors: Pascual-Ramírez
authors: M
authors: M
authors: Aguirre Sánchez-Covisa
authors: F
authors: F
authors: Araujo
authors: S
authors: S
authors: Gil Trujillo
authors: L G
authors: LG
authors: Collar
authors: S
authors: S
authors: Bocharán
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000818:Animals; D001127:Arginine Vasopressin / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D018849:Controlled Clinical Trials as Topic; D004353:Drug Evaluation, Preclinical; D005440:Fluid Therapy / Q000009:adverse effects; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology; D056747:Immunomodulation; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008833:Microcirculation / Q000187:drug effects; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology; D012462:Saline Solution, Hypertonic / Q000009:adverse effects / Q000627:therapeutic use*; D012772:Shock, Septic / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D034421:Sus scrofa; D013552:Swine; D000077585:Terlipressin; D019851:Thrombophilia / Q000209:etiology; D014667:Vasopressins / Q000627:therapeutic use*; D014883:Water-Electrolyte Imbalance / Q000209:etiology
chemical_list: D012462:Saline Solution, Hypertonic; D014667:Vasopressins; D001127:Arginine Vasopressin; D008236:Lypressin; D000077585:Terlipressin