Dobutamine and dopexamine and the splanchnic metabolic response in septic shock

Abstract

We report the case of a 41-year-old male with hyper-dynamic septic shock requiring noradrenaline in addition to volume resuscitation in order to maintain a mean arterial blood pressure >70 mmHg. However, despite satisfactory global haemodynamics and gas exchange, he exhibited persistent renal failure and hepatic dysfunction (MGEX 1,000 U/l) as well as gastric intramucosal acidosis (pHi 7.17). In an attempt to improve splanchnic O2 delivery we tested the effects of infusions of dobutamine (10 μg/kg/ min) and dopexamine (2 μg/kg/min). In addition to measuring splanchnic blood flow using the steady-state infusion indocyanine-green clearance technique, we analysed the hepatic metabolic response. The latter was estimated by determination of the hepatic glucose production rate (HGP), and splanchnic alanine uptake and lactate clearance. Both drugs comparably increased splanchnic blood flow and O2 availability. While both splanchnic O2 and alanin...