Document Detail


Abnormal pressor response to vasopressin in patients with cirrhosis: evidence for impaired buffering mechanisms.
MedLine Citation:
PMID:  2373486     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In patients with cirrhosis, vasopressin infusion induces sustained vasoconstriction and elevation of arterial pressure. The vasopressor effect could be caused by impairment of mechanisms normally aimed at buffering increases in arterial pressure (reflex bradycardia and decreases in arteriolar resistance). We studied the acute effects of continuous vasopressin infusion (0.4 IU/min) on systemic hemodynamics in seven patients with cirrhosis and in six patients without cirrhosis (controls). Vasopressin effects on systemic O2 consumption were also studied. In both groups, vasopressin infusion induced similar peak increases in arterial pressure, followed by similar decreases in heart rate and cardiac output. However, cirrhotic patients and controls differed 30 min after the start of vasopressin infusion. At 30 min, mean arterial pressure, diastolic arterial pressure and systemic vascular resistance remained significantly higher than preinfusion values in patients with cirrhosis. No decrease in systemic O2 consumption occurred in cirrhotic patients. In controls, at 30 min, mean arterial pressure and diastolic arterial pressure had returned to baseline. Systemic vascular resistance was not significantly higher than the preinfusion value and systemic O2 consumption had significantly decreased to below preinfusion values. We conclude that the vasopressor effect of vasopressin is abnormally sustained in patients with cirrhosis. This might be caused by insufficient buffering of vasopressin-induced arteriolar constriction rather than by abnormal vagal control of heart rate. In turn, as suggested by the lack of a decrease in systemic O2 consumption, persistent arteriolar constriction might be related to abnormally sustained sympathetic vascular tone in patients with cirrhosis.
Authors:
R Moreau; A Hadengue; T Soupison; G Mechin; M Assous; J Roche-Sicot; C Sicot
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Hepatology (Baltimore, Md.)     Volume:  12     ISSN:  0270-9139     ISO Abbreviation:  Hepatology     Publication Date:  1990 Jul 
Date Detail:
Created Date:  1990-08-24     Completed Date:  1990-08-24     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  8302946     Medline TA:  Hepatology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  7-12     Citation Subset:  IM    
Affiliation:
Service de Réanimation et de Médecine d'Urgence, Hôpital Emile Roux, Eaubonne, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Pressure / drug effects
Female
Heart Rate / drug effects
Hemodynamics / drug effects*
Humans
Infusions, Intravenous
Liver Cirrhosis / physiopathology*
Lypressin / administration & dosage,  pharmacology*
Male
Oxygen Consumption / drug effects
Potassium / blood*
Reference Values
Sodium / blood*
Vascular Resistance / drug effects
Chemical
Reg. No./Substance:
50-57-7/Lypressin; 7440-09-7/Potassium; 7440-23-5/Sodium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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