Document Detail


Increased sympathetic nervous activity and the effects of its inhibition with clonidine in alcoholic cirrhosis.
MedLine Citation:
PMID:  1739234     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To study disturbances in sympathetic nervous system function in patients with alcoholic cirrhosis and the effect of clonidine on such disturbances. DESIGN: Cross-sectional physiologic and neurochemical evaluation of patients with cirrhosis and of healthy controls; an uncontrolled trial of intravenous clonidine in the cirrhotic patients. PATIENTS: Forty-four hospitalized patients with biopsy-proven alcoholic cirrhosis and 31 healthy controls. INTERVENTIONS: Intravenous clonidine. MAIN OUTCOME MEASURES: Radiotracer-derived measures of norepinephrine release to plasma, central hemodynamics, wedge hepatic vein pressure, and measures of renal function. MAIN RESULTS: In patients with cirrhosis, clonidine reduced previously elevated norepinephrine overflow rates for the whole body, kidneys, and hepatomesenteric circulation. This sympathetic inhibition was accompanied by the following potentially clinically beneficial effects: the lowering of renal vascular resistance (median reduction, 24%; 95% CI, 14% to 31%), the elevation of glomerular filtration rate (median increase, 27%; CI, 14% to 39%), and the reduction of portal venous pressure (median reduction, 25%; CI, 18% to 32%). The norepinephrine and hemodynamic responses to graded clonidine dosing (1, 2, and 3 micrograms/kg body weight intravenously) indicated that the sympathetic outflow to the hepatomesenteric circulation was more sensitive to pharmacologic suppression with clonidine than was the sympathetic outflow to the systemic circulation. CONCLUSIONS: The sympathetic nerves to the kidneys, heart, and hepatomesenteric circulation are stimulated in patients with cirrhosis. Clonidine inhibits these activated sympathetic outflows differentially, which could possibly provide a basis for the selective pharmacologic treatment of portal hypertension in patients with cirrhosis.
Authors:
M Esler; F Dudley; G Jennings; H Debinski; G Lambert; P Jones; B Crotty; J Colman; I Willett
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  116     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1992 Mar 
Date Detail:
Created Date:  1992-03-16     Completed Date:  1992-03-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  446-55     Citation Subset:  AIM; IM    
Affiliation:
Alfred Hospital, Prahran, Australia.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Clonidine / pharmacology*
Cross-Sectional Studies
Female
Hemodynamics / drug effects
Humans
Kidney / drug effects,  physiopathology
Liver Cirrhosis, Alcoholic / blood,  physiopathology*
Male
Middle Aged
Norepinephrine / blood
Portal Vein / drug effects
Sympathetic Nervous System / drug effects,  physiopathology*
Venous Pressure / drug effects
Chemical
Reg. No./Substance:
4205-90-7/Clonidine; 51-41-2/Norepinephrine
Comments/Corrections
Comment In:
Ann Intern Med. 1992 Mar 15;116(6):515-7   [PMID:  1739244 ]

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


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