Epinephrine septic

Vasopressin is a peptide hormone produced by the hypothalamus and secreted by the posterior pituitary in response to stimulation. Normal stimuli for vasopressin release are hyperosmolarity and hypovolemia, with thresholds for secretion of greater than 280 mOsm/kg and greater than 20% plasma volume depletion. A number of other stimuli, such as pain, nausea, epinephrine, and numerous drugs, induce release of vasopressin. Vasopressin release is inhibited by volume expansion, ethanol, and norepinephrine. The physiological effect of vasopressin is to promote free water clearence by altering the permeability of the renal collecting duct to water. In addition, it has a direct vasoconstrictor effect. Consequently, vasopressin results in water retention and volume restoration. In patients with septic shock, vasopressin is appropriately secreted in response to hypovolemia and to elevated serum osmolarity (R14). 

Epinephrine exerts combined a- and /8-agonist effects. At the high epinephrine infusion rates used in septic shock, predominantly... 

Recent studies have focused on the effects of dobutamine on gastric mucosal flow and the splanchnic circulation. The addition of dobutamine (held constant at 5 mcg/kg per minute) to norepinephrine improves gastric mucosal perfusion without increasing cardiac index. This is consistent with findings that dobutamine may improve pHi and mucosal perfusion in septic patients. The addition of dobutamine to epinephrine-treated patients has been shown to improve gastric mucosal perfusion, as measured by improvements in pHi, arterial lactate concentrations, and PCO2 gap. Duranteau and colleagues ... 

Meier-Hellmann A, Reinhart K, Bredle DL, et al. Epinephrine impairs splanchnic perfusion in septic shock. Crit Care Med 1997 25 399-404. 

De Backer D, Creteur J, Silva E, Vincent JL. Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock Which is best Crit Care Med 2003 31 1659-1667. 

Duranteau J, Sitbon P, Teboul JL, et al. Effects of epinephrine, norepinephrine, or the combination of norepinephrine and dobutamine on gastric mucosa in septic shock. Crit Care Med 1999 27 893-900. 

Seguin P, Bellissant E, Le Tulzo Y, et al. Effects of epinephrine compared with the combination of dobutamine and norepinephrine on gastric perfusion in septic shock. Clin Pharmacol Ther 2002 71 381-388. 

Zhou SX, Qiu HB, Huang YZ, et al. Effects of norepinephrine, epinephrine, and norepinephrine-dobutamine on systemic and gastric mucosal oxygenation in septic shock. Acta Pharmacol Sin 2002 23 654-658. 

---