A 78 yo patients presents with tachycardia and hypotension. There has been a recent episode of dysuria and the diagnosis of urosepsis is made. Antibiotics are given as you give a 500mL fluid challenge with normal saline and the blood pressure responds….briefly. You continue the fluid challenge, each time there is a transient increase in blood pressure.
You decide to commence Noradrenaline and you escalate the dose. The patient’s blood pressure is not responding as needed, so you add Vasopressin. The patient is responding, but you are reaching high levels of vasopressors.
We know that high doses of vasopressors can have adverse effects, including peripheral ischaemia, arrhythmias, and myocardial depression and increased mortality……. enter methylene blue. Can this make a difference?
Sepsis is associated with abnormal nitric oxide metabolism, increased vasodilatation and increased vascular permeability. Methylene blue inhibits nitric oxide synthase and can restore vasoregulation.
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