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British Journal of Anaesthesia, 2001, Vol. 86, No. 4 578-580
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Circulating tetrahydrobiopterin concentrations in patients with septic shock

H. F. Galley1, A. E. Le Cras1, K. Yassen2,3, I. S. Grant2 and N. R. Webster1

1Academic Unit of Anaesthesia and Intensive Care, University of Aberdeen, Aberdeen AB25 2ZD, UK. 2Intensive Care Unit, Western General Hospital, Edinburgh, UK. 3Present address: Menoufiya University Hospital, Egypt*Corresponding author

Nitric oxide synthase requires tetrahydrobiopterin for its activity. In animal models of sepsis, changes in circulating tetrahydrobiopterin concentrations precede increases in nitrate. We measured plasma tetrahydrobiopterin and nitrate concentrations on three consecutive days in 10 patients with septic shock and 10 critically ill control patients. Total nitrate concentration was measured after reduction of nitrite to nitrate. Tetrahydrobiopterin concentrations were measured using HPLC. The median (range) APACHE II score was 22 (13–27) in the patients with septic shock and 25 (7–28) in the control group. The nitrate concentration was significantly higher in patients with septic shock than in controls (P=0.01) on all days but did not change with time. Tetrahydrobiopterin concentrations were highest in the patients with septic shock on day 1 only (P=0.037). In the seven patients with renal failure, both nitrate and tetrahydrobiopterin concentrations tended to be higher than in the 13 patients without renal failure. The nitrate concentration correlated with tetrahydrobiopterin concentration on day 1 only (P=0.05). In patients with septic shock, both tetrahydrobiopterin and total nitrate concentrations were higher than those in critically ill controls but were increased mainly in patients with renal failure. In summary, tetrahydrobiopterin concentration increases during septic shock, in line with increases in nitrate concentration. However, as for nitrate, concentrations are affected by renal function. Measurement of tetrahydrobiopterin concentration is extremely technically demanding and time consuming and offers no advantage over measurement of nitrate concentration.

Br J Anaesth 2001; 86: 578–80


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