Effect of Dopexamine on Hepatic Metabolic Activity in Patients With Septic Shock

Kiefer, P; Tugtekin, I.; Wiedeck, Heide; Vogt, J.; Wachter, U.; Bracht, Hendrik; Geldner, Götz; Georgieff, Michael; Radermacher, Peter

doi:10.1097/00024382-200115060-00003

Cited by 16 publications

(8 citation statements)

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“…Furthermore, in patients with septic shock treated for 24 hrs either with dobutamine (5 g·kg·min Ϫ1 ) or dopexamine (1 g·kg·min Ϫ1 ) after hemodynamic stabilization with volume resuscitation and norepinephrine, dobutamine only resulted in a normalization of the plasma hyperlactatemia and the lactate/ pyruvate ratios (145). Kiefer et al (146) finally confirmed this lacking beneficial effect of dopexamine on intermediary metabolism in patients already treated with continuous intravenous norepinephrine. Increasing cardiac output and hepatosplanchnic blood flow did not change any measured parameter of energy expenditure, glucose formation rate, the uptake rate of different glucose precursors nor blood lactate/pyruvate, or ketone body ratios.…”

Section: Catecholamine Effects On Glucose Metabolism Under Pathophysimentioning

confidence: 95%

“…Both in experimental animals, as well as in critically ill patients, several authors have investigated the effects combining norepinephrine with dopamine, dobutamine, and dopexamine (143)(144)(145)(146)(147). Despite the unanimous observation that both dobutamine and dopexamine increased cardiac output concomitant with a passive rise in hepatosplanchnic blood flow, the metabolic response to this intervention was always fairly moderate.…”

Section: Catecholamine Effects On Glucose Metabolism Under Pathophysimentioning

confidence: 99%

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Glucose metabolism and catecholamines

Barth

Albuszies

Baumgart

et al. 2007

Critical Care Medicine

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296

201

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Until now, catecholamines were the drugs of choice to treat hypotension during shock states. Catecholamines, however, also have marked metabolic effects, particularly on glucose metabolism, and the degree of this metabolic response is directly related to the beta2-adrenoceptor activity of the individual compound used. Under physiologic conditions, infusing catecholamine is associated with enhanced rates of aerobic glycolysis (resulting in adenosine triphosphate production), glucose release (both from glycogenolysis and gluconeogenesis), and inhibition of insulin-mediated glycogenesis. Consequently, hyperglycemia and hyperlactatemia are the hallmarks of this metabolic response. Under pathophysiologic conditions, the metabolic effects of catecholamines are less predictable because of changes in receptor affinity and density and in drug kinetics and the metabolic capacity of the major gluconeogenic organs, both resulting from the disease per se and the ongoing treatment. It is also well-established that shock states are characterized by a hypermetabolic condition with insulin resistance and increased oxygen demands, which coincide with both compromised tissue microcirculatory perfusion and mitochondrial dysfunction. This, in turn, causes impaired glucose utilization and may lead to inadequate glucose supply and, ultimately, metabolic failure. Based on the landmark studies on intensive insulin use, a crucial role is currently attributed to glucose homeostasis. This article reviews the effects of the various catecholamines on glucose utilization, both under physiologic conditions, as well as during shock states. Because, to date (to our knowledge), no patient data are available, results from relevant animal experiments are discussed. In addition, potential strategies are outlined to influence the catecholamine-induced effects on glucose homeostasis.

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Section: Catecholamine Effects On Glucose Metabolism Under Pathophysimentioning

confidence: 95%

Section: Catecholamine Effects On Glucose Metabolism Under Pathophysimentioning

confidence: 99%

Glucose metabolism and catecholamines

Barth

Albuszies

Baumgart

et al. 2007

Critical Care Medicine

Self Cite

296

201

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“…Eine Erhöhung des Blutflusses im Gastrointestinaltrakt unter Therapie mit Dopexamin konnte in verschiedenen Studien gezeigt werden [16,21,32]. Eine solche Blutflusserhöhung würde über eine Flusserhöhung in der Leber auch zu einer erhöhten Extraktion von ICG füh-ren; ICG wird ausschließlich von der Leber aus dem Blut in die Galle extrahiert, eine relevante extrahepatische Elimination existiert nicht [11,27].…”

Section: Diskussionunclassified

“…Dopexamin hatte dabei jedoch keinen Einfluss auf verschiedene Stoffwechselparameter der Leber,wie z.B.den hepatosplanchnischen Umsatz von Laktat, Pyruvat, Alanin und Glutamin sowie die endogene Glukoseproduktion[16].Iloprost hat in der vorliegenden Untersuchung die PDR von ICG im septischen Schock reversibel erhöht.Auch hier kann aufgrund des unveränderten HI sowie des konstanten ITBV und ZVD ein Volumeneffekt ausgeschlossen werden.Dass Iloprost durch seine vasodilatatorische Wirkung den Blutfluss im Gastrointestinaltrakt steigern kann, konnte im experimentellen Setting bereits gezeigt werden[13,20,34]. In einer klinischen Studie von Kiefer et albei Patienten im septischen Schock stand allerdings die Erhöhung des Blutflusses im Splanchnikusgebiet im Gegensatz zu unserer Arbeit mit einer Erhö-hung des HI in Zusammenhang[15].Ein wichtiger Faktor mit Einfluss auf die Leberfunktion im septischen Schock ist die Freisetzung von Tumor-Nekrose-Faktor α (TNF-α).…”

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Einfluss von Dopexamin und Iloprost auf die Plasma-Disappearance-Rate von Indozyaningr�n bei Patienten im septischen Schock

et al. 2003

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“…Such an enhancement in global O 2 demand could be greater than the improvement of regional circulation in critically ill patients (20). This suggests that reducing VO 2 of some organs, such as the heart myocardium and respiratory muscles, might be beneficial and could restore the overall balance of O 2 supply and demand.…”

Section: Introductionmentioning

confidence: 99%

Effects of Dopamine and Norepinephrine on Systemic and Hepatosplanchnic Hemodynamics, Oxygen Exchange, and Energy Balance in Vasoplegic Septic Patients

Guérin¹,

Levraut²,

Samat-Long³

et al. 2005

Shock

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Dopamine is widely used to improve systemic and hepatosplanchnic hemodynamics and oxygenation during sepsis. However, some studies have suggest that norepinephrine may have beneficial effects on regional blood flow and metabolism, whereas dopamine might have deleterious effects related to redistribution of blood flow away from the intestinal mucosa or by decreasing directly the cell redox state. In 12 vasoplegic septic patients, we compared the effects of norepinephrine and dopamine on systemic and hepatosplanchnic hemodynamics, oxygenation, and energy metabolism. Catecholamines were administered in a crossover randomized order to maintain mean arterial pressure (MAP) at 80 mmHg. Hepatosplanchnic blood flow (Qspl) was determined using a continuous infusion of indocyanine green dye. Despite a similar MAP, the cardiac index was higher with dopamine than with norepinephrine (6.3 [5.3-7.3] vs. 4.3 [3.8-4.9] L.min.m) (P <0.001). Qspl was similar with both catecholamines, but the ratio of Qspl to cardiac output was significantly lower with dopamine (23.9% [17.5-33.5]) than with norepinephrine (33.5% [25.8-37]) (P <0.05). Although global O2 delivery and O2 consumption were higher with dopamine (782 [707-859] vs. 553 [512-629] mL.min.m, P <0.001 and 164 [134-192] vs. 128 [111-149] mL.min.m, P <0.001, respectively), hepatosplanchnic O2 delivery and consumption were not different. Hepatic lactate uptake was lower (0.47 [0.3-0.89] vs. 1.01 [0.69-1.34] mmol.min) (P <0.01), and hepatic venous lactate-to-pyruvate ratio was higher (15.3 [7.6-21.1] vs. 11.2 [6.6-15.1], P <0.05) with dopamine than with norepinephrine. In vasoplegic septic patients, maintaining mean arterial pressure, hepatosplanchnic hemodynamics, and oxygen exchange with dopamine requires a consequent increased cardiac output, which is responsible for an increased global oxygen demand when compared with norepinephrine. In addition, dopamine impairs the hepatic energy balance. Its position as a preferential treatment compared with norepinephrine in this context may therefore be questionable.

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Effect of Dopexamine on Hepatic Metabolic Activity in Patients With Septic Shock

Cited by 16 publications

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Glucose metabolism and catecholamines

Glucose metabolism and catecholamines

Einfluss von Dopexamin und Iloprost auf die Plasma-Disappearance-Rate von Indozyaningr�n bei Patienten im septischen Schock

Effects of Dopamine and Norepinephrine on Systemic and Hepatosplanchnic Hemodynamics, Oxygen Exchange, and Energy Balance in Vasoplegic Septic Patients

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