cyclic-gmp and Shock--Cardiogenic

Methylene blue is used primarily in the treatment of patients with methemoglobinemia. Most recently, methylene blue has been used as a treatment for refractory distributive shock from a variety of causes such as sepsis and anaphylaxis. Many studies suggest that the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway plays a significant role in the pathophysiology of distributive shock. There are some experimental and clinical experiences with the use of methylene blue as a selective inhibitor of the NO-cGMP pathway. Methylene blue may play a role in the treatment of distributive shock when standard treatment fails.

Topics: Anaphylaxis; Animals; Antidotes; Cyclic GMP; Drug Resistance; Endothelium, Vascular; Enzyme Inhibitors; Humans; Isoenzymes; Methylene Blue; Models, Biological; Muscle, Smooth, Vascular; Nitric Oxide; Nitric Oxide Synthase; Second Messenger Systems; Sepsis; Shock; Shock, Cardiogenic; Vascular Resistance

Shock can be defined as the failure of the circulatory system to provide necessary cellular nutrients, including oxygen, and to remove metabolic wastes. Although it is now recognized that more than 100 different forms of shock exist, this recognition is more a reflection of the widespread use of the term to describe a variety of disease states. For the purpose of this monograph, we concentrate on various forms of cardiovascular shock, in particular, shock that may be linked to inappropriate vasodilation from overproduction of the endogenous vasodilator, nitric oxide. Some forms of shock have been extensively studied, and convincing evidence exists for the role of nitric oxide. Other disease states have been less well characterized in terms of their association with excess nitric oxide production. Available evidence of a role for nitric oxide is discussed in the hope of stimulating the interest of investigators to explore these areas more thoroughly.

Topics: Anaphylaxis; Animals; Cyclic GMP; Cytokines; Depression, Chemical; Endothelium; Enzyme Inhibitors; Heart; Humans; Nitric Oxide; Nitric Oxide Synthase; Oxygen Consumption; Shock, Cardiogenic; Shock, Septic; Toxins, Biological; Vasodilation