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, 25 (9), 1588-93

Circulating Methemoglobin and Nitrite/Nitrate Concentrations as Indicators of Nitric Oxide Overproduction in Critically Ill Children With Septic Shock

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Circulating Methemoglobin and Nitrite/Nitrate Concentrations as Indicators of Nitric Oxide Overproduction in Critically Ill Children With Septic Shock

B Krafte-Jacobs et al. Crit Care Med.

Abstract

Objectives: To examine the relationship between circulating methemoglobin and nitrite/nitrate concentrations and to compare these markers of nitric oxide overproduction with clinical variables in children diagnosed with septic shock.

Design: Prospective, controlled, clinical study.

Setting: Pediatric intensive care unit and outpatient clinic in a children's hospital.

Patients: Twenty-two children diagnosed with septic shock and ten age-matched healthy control patients.

Interventions: Patients diagnosed with septic shock had blood specimens taken on study entry and every 6 hrs for 72 hrs for methemoglobin and nitrite/nitrate determinations. Single blood specimens were obtained from controls.

Measurements and main results: Circulating methemoglobin and nitrite/nitrate concentrations were significantly higher in children diagnosed with septic shock in comparison with healthy control children (p = .01 and .05, respectively). Peak nitrite/nitrate concentrations correlated with serum creatinine (r2 = .19; p = .04) and were inversely correlated with arterial pH (r2 = .28; p = .01) and urine output (r2 = .21; p = .03) when analyzed by log-linear regression. There were no significant relationships between methemoglobin and nitrite/nitrate or between methemoglobin and any other clinical variable.

Conclusions: Circulating methemoglobin and nitrite/nitrate concentrations are increased in children diagnosed with septic shock. Plasma nitrite/nitrate values correlate with selected clinical variables in these children. Circulating methemoglobin measurements are not superior to plasma nitrite/nitrate concentrations as an indicator of endogenous overproduction of nitric oxide in children diagnosed with septic shock. A need remains to develop markers of endogenous nitric oxide activity that have greater accuracy and reliability.

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