Abstract
SEVERAL REPORTS HAVE DESCRIBED the use of naloxone in patients with refractory hypotension secondary to sepsis. '3 In one 8-year-old child with meningococcemia, the blood pressure, which had been unresponsive to conventional treatment, normalized after the administration of naloxone.: We report two neonates with overwhelming sepsis whose blood pressure was unresponsive to conventional treatment but dramatically improved within minutes of naloxone administration. CASE REPORTS Patient 1. This 8-day-old, 2900 gm white infant girl was admitted to Children's Hospital because of lethargy and poor feeding. She was pale and slightly dusky, and markedly lethargic. Examination of the cerebrospinal fluid revealed WBC 468/tzL, protein 660 mg/dL, and glucose 4 mg/dl. The cultures of spinal fluid and blood subsequently grew group B streptococcus. Despite antibiotic therapy with ampicillin 300 mg/kg/day and gentamicin 7.5 mg/kg/day, the infant's condition deteriorated and she required mechanical ventilation 3 hours after admission. Generalized seizures were treated with phenobarbital, phenytoin, and diazepam. Further deterioration occurred rapidly, and the blood pressure did not respond to administration of 30 ml/kg fresh-frozen plasma and continuous infusion of increasing doses of dopamine to a maximum of 30 ug/kg/min; methylprednisolone 30 mg/kg also had no effect. After informed consent was obtained, naloxone thereby was initiated. An irfitial dose of 0.01 mg/kg intravenously had no effect on blood wessure, but a dose of 0.02 mg/kg resulted in a rise of 10 to 15 m~,Hg systolic and 5 to 10 mm Hg diastolic. The blood pressure remained high for approxi
Published Version
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