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 <10 μg/l, bilirubin 90 μmol/l and glutamate dehydrogenase >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 alanine uptake remained unchanged, the HGP fell by one-third, concomitant with a twofold increase in lactate clearance. We could not detect supply dependency of splanchnic O2 uptake. Since the decrease in HGP results in reduced hepatic O2 requirements, we nevertheless conclude that increasing splanchnic blood flow may improve hepatic metabolic performance in hyperdynamic septic shock. In our patient, neither of the two compounds exhibited any drug-specific benefit.