Vasopressin infusion

CRH probably does not act alone. According to clinical neuroendocrinology, vasopressin is a prime candidate for the synergy of CRH effects at pituitary CRHj receptors, and it also has behavioral effects that are compatible with a role in depression. Chronic psychosocial stress enhances vasopressin expression and increases the number of hypothalamic neurons coexpressing CRH and vasopressin. Infusion of an antisense oligodeoxy-nucleotide, which corresponds to the mRNA of vasopressin type 1 receptor, into the septum led to reduced anxiety-related behavior that parallels decreases in vasopressin receptor binding (Landgraf et al. 1995). 

Vasopressin and desmopressin are treatments of choice for pituitary diabetes insipidus. The dosage of desmopressin is 10-40 meg (0.1-0.4 mL) in two to three divided doses as a nasal spray or, as an oral tablet, 0.1-0.2 mg two to three times daily. The dosage by injection is 1-4 meg (0.25-1 mL) every 12-24 hours as needed for polyuria, polydipsia, or hypernatremia. Bedtime desmopressin therapy, by intranasal or oral administration, ameliorates nocturnal enuresis by decreasing nocturnal urine production. Vasopressin infusion is effective in some cases of esophageal variceal bleeding and colonic diverticular bleeding. 

Purpuric skin necrosis, due to local vasoconstriction, has been reported in 19 patients within a few days of starting vasopressin infusion (27). 

A review of trials has suggested that vasopressin is more likely to cause adverse effects at doses of 0.04 U/minute or more when it is used to treat septic shock mesenteric ischemia and cardiac dysfunction and ischemia were particularly associated with high doses (30). The authors suggested that limiting the dosage to 0.03 U/minute may minimize these effects. This suggestion has been supported by a retrospective audit of the effects of continuous vasopressin infusion in septic shock in 102 men and women, mean age 53 years (31). There were adverse events that may have been linked to vasopressin in 18 patients cardiac arrest (n = 9) ischemic/mottled digits (n = 8) myocardial infarction (n = 1) and hyponatremia (n = 1). Adverse events occurred with doses of vasopressin of 0.04 units/minute and over, except in one patient (dose not stated). 

Moreno-Sanchez D, Casis B, Martin A, Ortiz P, Castellano G, Munoz MT, Vanaclocha F, Solis-Herruzo JA. Rhabdomyolysis and cutaneous necrosis following intravenous vasopressin infusion. Gastroenterology 1991 101(2) 529-32. 

Dunser MW, Mayr AJ, Tur A, Pajk W, Barbara F, Knotzer H, Ulmer H, Hasibeder WR. Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock incidence and risk factors. Crit Care Med 2003 31 1394-8. 

Obritsch MD, Jung R, Fish DN, MacLaren R. Effects of continuous vasopressin infusion in patients with septic shock. Ann Pharmacother 2004 38 1117-22. 

Vasopressin and desmopressin are the alternative treatments of choice for pituitary diabetes insipidus. Bedtime desmopressin therapy ameliorates nocturnal enuresis by decreasing nocturnal urine production. Vasopressin infusion is effective in some cases of esophageal variceal bleeding and colonic diverticular bleeding. 

Ishii H, Saitoh T, Ishikawa I (1997) Wedge-shaped enhancement on delayed CT scan during vasopressin infusion in rats (in Japanese with English abstract). J Kanazawa Med Univ 22 15-25... 

Gomes AS, Lois JF, McCoy RD (1986) Angiographic treatment of gastrointestinal hemorrhage comparison of vasopressin infusion and embolization. AJR Am J Roentgenol 146 1031-1037... 

Therapeutic vasopressin infusion into the main arterial trunks induces visceral vasospasm, enhancing the physiological vasoconstrictive reaction against bleeding. Initial enthusiasm about vasopressin infusion ebbed away because of less favorable results compared to embolization [79-81], and the systemic side effects [82]. Vasopressin infusion has been shown more effective in lower than in upper GIH. 

Darcy M (2003) Treatment of lower gastrointestinal bleeding vasopressin infusion versus embolization. J Vase Interv Radiol 14 535-543... 

If it is not possible to pass the catheter selectively enough to permit safe embolization, alternate approaches need to be considered. The initial approach may be to fall back to the well established methods of vasopressin infusion. Some of the main benefits of a vasopressin... 

Ikegami H, Funato M, Tamai H, Wada H, Nabetani M, Nishihara M. Low-dose vasopressin infusion therapy for refractory hypotension in ELBW infants. Pediatr Int 2010 52(3) 368-73. 

Hasibeder WR, Grander W, Dunser MW. Plasma copeptin levels before and during exogenous arginine vasopressin infusion in patients with advanced vasodilatory shock. Minerva Anestesiol 2010 76(11) 905-12. 

Iwamoto H, Rudolph A, Keil L, Heymann M. Hemodynamic responses of the sheep fetus to vasopressin infusion. Circ Res 1979 44(3) 430-436. 

Examination of data from neonates who had xmdergone complex cardiac surgery either with (n = 17) or without (n = 17) the use of vasopressin foxmd that vasopressin treatment was associated with higher urea and creatinine levels, longer period of peritoneal dialysis, reduced platelet coxmts and delayed recovery of lactate concentration [97 ]. The authors suggest that vasopressin infusion should only be used in catecholamine-refractory shock. The potentially dangerous outcomes reported in this study should be assessed carefully in future trials. 

Alten JA, Borasino S, Toms R, Law MA, MoeUinger A, Dabal RJ. Early initiation of arginine vasopressin infusion in neonates after complex cardiac surgery. Pediatr Crit Care Med 2012 13(3) 300-4. Epub 2011/09/20. 

Nishibe S, Tsujita M. The impact of intraoperative vasopressin infusion in complex neonatal cardiac surgery. Interact Cardiovasc Thorac... 

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