Utilization of methylene blue in the setting of hypotension associated with concurrent renal and hepatic failure: a concise review

Bosoy, Dimitry; Axelband, Jennifer; Pursell, Robert N.; Lukaszczyk, John J. and Stawicki, S. Peter (2008) Utilization of methylene blue in the setting of hypotension associated with concurrent renal and hepatic failure: a concise review. OPUS 12 Scientist, 2 (1). pp. 21-29. ISSN 1940-8633

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Abstract

Renal failure, hepatic failure and hepatorenal syndrome can be associated with clinically significant hypotension, a clinical state often referred to as vasoplegia or vasoplegic syndrome. Vasoplegia is thought to be related to dysregulation of endothelial homeostasis and subsequent endothelial dysfunction due to direct and indirect effects of various inflammatory mediators. Vasoplegia has been observed in all age groups and in various clinical settings, including sepsis, hemorrhagic shock, hemodialysis, and cardiac surgery. Among mechanisms thought to be contributory to vasoplegic syndrome, the nitric oxide/cyclic guanosine monophosphate pathway appears to play a prominent role. Methylene blue, an inhibitor of nitric oxide synthase and guanylate cyclase, has been found to improve the hypotension associated with various clinical states. Evidence also suggests that methylene blue may be effective in improving systemic hemodynamics and vasoplegia associated with hepatic failure. We describe two cases of vasoplegia associated with concurrent hepatic and renal failure – both demonstrating a favorable hemodynamic response to methylene blue without apparent side effects. A review of methylene blue use in the setting of hepatic and renal failure then follows.

EPrint Type:Article
Additional Information:Citation: Bosoy D, Axelband J, Pursell RN, Lukaszczyk JJ, Stawicki SP. Utilization of methylene blue in the setting of hypotension associated with concurrent renal and hepatic failure: A concise review. OPUS 12 Scientist 2008;2(1):21-29.
Uncontrolled Keywords:Methylene blue, Hepatic failure, Renal failure, Vasoplegic syndrome, Vasoplegia, Hypotension, Vasopressors
Subjects:Digestive System Diseases > Liver Diseases > Liver Failure
Digestive System Diseases > Liver Diseases > Fatty Liver
Investigative Techniques > Chemistry, Analytical > Dialysis
-Journal Repositories > OPUS 12 Scientist
Cardiovascular Diseases > Vascular Diseases > Hypotension
Therapeutics > Renal Replacement Therapy
Digestive System Diseases > Liver Diseases > Liver Cirrhosis
Inorganic Chemicals > Free Radicals > Nitric Oxide
Digestive System > Liver
Heterocyclic Compounds > Heterocyclic Compounds, 3-Ring > Phenothiazines
ID Code:2830
Deposited By:Dr S. Peter Stawicki
Deposited On:29 April 2008

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