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Naloxone in treatment of circulatory shock resistant to conventional therapy

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Summary

The effect of naloxone (4.4–5.9 mg i.v.) was evaluated in 10 patients with circulatory shock (sepsis,n=7; intoxication,n=1; cardiogenic shock,n=2) not responding to full conventional therapy. In addition, we measured plasma ACTH and immunoreactive β-endorphin before and 60 min after administration of naloxone and compared the results with hormone concentrations in 10 intensive care patients without shock. Only in two patient with septic shock a transient increase (duration 15 min and 60 min, respectively) of systolic blood pressure was observed, while naloxone was ineffective in the remaining eight patients. No adverse effects of naloxone were found. Plasma ACTH and immunoreactive β-endorphin concentrations in patients with shock were not different from those in controls (ACTH, 79±28 vs 120±60 pg/ml; immunoreactive β-endorphin, 952±262 vs 1,070±378 pg/ml).

Our findings suggest that naloxone in a single dose of 4.4–5.9 mg i.v. does not improve the management of circulatory shock unresponsive to conventional treatment. β-endorphin seems to play no major role in the hypotension of shock.

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Abbreviations

ACTH:

Adrenocorticotrophic hormone

HD:

intermittent hemodialysis

HF:

heart rate

ir:

immunoreactive

RRsyst :

systolic blood pressure

References

  1. Allolio B, Winkelmann W, Hipp FX (1981) Effect of meclastine, an H1-antihistamine, on plasma ACTH in adrenal insufficiency. Acta Endocrinol (Kbh) 96:98–102

    Google Scholar 

  2. Bernton EW, Long JB, Holaday JW (1985) Opioids and neuropeptides: mechanisms in circulatory shock. Fed Proc 44:290–299

    Google Scholar 

  3. Bonnet F, Bilaine J, Lhoste F, Mankikian B, Kerdelhue B, Rapin M (1985) Naloxone therapy of human septic shock. Crit Care Med 13:972–975

    Google Scholar 

  4. Curtis MT, Lefer AM (1980) Protective actions of naloxone in hemorrhagic shock. Am J Physiol 239:H416-H421

    Google Scholar 

  5. De Maria A, Craven DE, Heffernan JJ, McIntosh TK, Grindlinger GA, McCabe WR (1985) Naloxone versus placebo in treatment of septic shock. Lancet I:1363–1365

    Google Scholar 

  6. Dirksen R, Otten MH, Wood GJ, Verbaan CJ, Haalebos MMP, Verdouw PV, Nijhuis GMM (1980) Naloxone in irreversible shock. Lancet II:1360–1361

    Google Scholar 

  7. Faden AI, Holaday JW (1980) Naloxone treatment of endotoxin shock: stereospecificity of physiologic and pharmacologic effects in the rat. J Pharmacol Exp Ther 212:441–447

    Google Scholar 

  8. Faden AI, Holaday JW (1980) Experimental endotoxin shock: the pathophysiologic function of endorphins and treatment with opiate antagonists. J Infect Dis 142:229–238

    Google Scholar 

  9. Faden AI, Jacobs ThP, Holaday JW (1981) Opiate antagonist improves neurologic receovery after spinal injuny. Science 211:493–494

    Google Scholar 

  10. Groeger JS, Carlon GC, Howland WS (1983) Naloxone in septic shock. Crit Care Med 11:650–654

    Google Scholar 

  11. Guillemin R, Vargo T, Rossier J, Minich S, Ling N, Rivier C, Vale W, Bloom F (1977) β-Endorphin and adrenocorticotropin are secreted concomitantly by the pituitary gland. Science 197:1367–1369

    Google Scholar 

  12. Gurll N (1983) Naloxone in endotoxic shock: experimental models and clinical perspective. Adv Shock Res 10:63–71

    Google Scholar 

  13. Gurll NJ, Reynolds DG, Vargish T, Lechner RB (1982) Naloxone without transfusion prolongs survival and enhances cardiovascular function in hypovolemic shock. J Pharmacol Exp Ther 220:621–624

    Google Scholar 

  14. Holaday JW (1983) Cardiovascular effects of endogenous opiate system. Annu Rev Pharmacol Toxicol 23:541–594

    Google Scholar 

  15. Holaday JW, Faden AI (1980) Naloxone acts at central opiate receptors to reverse hypotension, hypothermia and hypoventilation in spinal shock. Brain Res 189:295–299

    Google Scholar 

  16. Holaday JW, Faden AI (1978) Naloxone reversal of endotoxic hypotension suggests role of endorphins in shock. Nature 275:450–451

    Google Scholar 

  17. Jeffcoate WJ, Rees LH, Lowry PJ, Besser GM (1978) A specific radioimmunoassay for human β-lipotropin. J Clin Endocrinol Metab 47:160–166

    Google Scholar 

  18. Martin WR (1976) Naloxone. Ann Intern Med 85:765–768

    Google Scholar 

  19. Peters WP, Johnson MW, Friedman PA, Mitch WE (1981) Pressor effect of naloxone in septic shock. Lancet I:529–532.

    Google Scholar 

  20. Raymond RM, Harkema JM, Stoffs WV, Emerson ThE (1981) Effects of naloxone therapy on hemodynamics and metabolism following a supralethal dosage ofEscherichia coli endotoxin in dogs. Surg Gynecol Obstet 152:159–162

    Google Scholar 

  21. Reynolds DG, Gurll NJ, Vargish T, Lechner R, Faden AI, Holaday JW (1980) Blockade of opiate receptors with naloxone improves survival and cardiac performance in canine endotoxic shock. Circ Shock 7:39–48

    Google Scholar 

  22. Rock P, Silverman H, Plump D, Kecala Z, Smith Ph, Michael JR, Summer W (1985) Efficacy and safety of naloxone in septic shock. Crit Care Med 13:28–33

    Google Scholar 

  23. Tiengo M (1980) Naloxone in irreversible shock. Lancet II:690

    Google Scholar 

  24. Vargish T, Reynolds DG, Gurll NJ, Lechner RB, Holaday JW, Faden AI (1980) Naloxone reversal of hypovolaemic shock in dogs. Circ Shock 7:31–38

    Google Scholar 

  25. Wright DJM, Philips M, Weller MPI (1980) Naloxone in shock. Lancet II:1361

    Google Scholar 

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Supported by Landesamt für Forschung, NRW

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Allolio, B., Fischer, H., Kaulen, D. et al. Naloxone in treatment of circulatory shock resistant to conventional therapy. Klin Wochenschr 65, 213–217 (1987). https://doi.org/10.1007/BF01715847

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  • DOI: https://doi.org/10.1007/BF01715847

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