PMC3099204_01
Haemodynamic parameters over the intensive care period.
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fig1
A further 3 litres of intravenous fluid were administered, but she remained anuric and her blood pressure remained at 75 mmHg systolic (mean arterial pressure (MAP) 45-50 mmHg (see Table 1 and Figures 1 and 2). At this time (18 hrs after presentation to ED, Figures 1, 2, 4, and 5), she was refractory to vasopressin (0.02 units hr-1), adrenaline (0.24 mcg kg-1 min-1), noradrenaline (0.29 mcg kg-1 min-1), glucagon (0.12 units hr-1), hyperinsulinaemia-euglycaemia (800 units hr-1), and calcium (3 mL kg-1 hr-1 of 10%).
Response of MAP in mmHg to infusions over the intensive care period. Note: left y-axis MAP in mmHg, right y-axis infusions of ionotropes in mcg kg-1 min-1. Arrows show metaraminol boluses.
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fig2
A further 3 litres of intravenous fluid were administered, but she remained anuric and her blood pressure remained at 75 mmHg systolic (mean arterial pressure (MAP) 45-50 mmHg (see Table 1 and Figures 1 and 2). As this was being setup, metaraminol (boluses of 0.5 mg) were administered producing a transient increase in MAP (Table 1, Figure 2). Due to a lack of response, adrenaline was also added along with a calcium infusion (Figure 2).  At this time (18 hrs after presentation to ED, Figures 1, 2, 4, and 5), she was refractory to vasopressin (0.02 units hr-1), adrenaline (0.24 mcg kg-1 min-1), noradrenaline (0.29 mcg kg-1 min-1), glucagon (0.12 units hr-1), hyperinsulinaemia-euglycaemia (800 units hr-1), and calcium (3 mL kg-1 hr-1 of 10%). The effect of metaraminol permitted the other ionotropes to be weaned over the next few hours (Figure 2).
The effect of hyperinsulinaemia-euglycaemia on MAP.
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fig4
At this time (18 hrs after presentation to ED, Figures 1, 2, 4, and 5), she was refractory to vasopressin (0.02 units hr-1), adrenaline (0.24 mcg kg-1 min-1), noradrenaline (0.29 mcg kg-1 min-1), glucagon (0.12 units hr-1), hyperinsulinaemia-euglycaemia (800 units hr-1), and calcium (3 mL kg-1 hr-1 of 10%).
The effect of metaraminol on urine output.
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fig5
At this time (18 hrs after presentation to ED, Figures 1, 2, 4, and 5), she was refractory to vasopressin (0.02 units hr-1), adrenaline (0.24 mcg kg-1 min-1), noradrenaline (0.29 mcg kg-1 min-1), glucagon (0.12 units hr-1), hyperinsulinaemia-euglycaemia (800 units hr-1), and calcium (3 mL kg-1 hr-1 of 10%). There was an immediate striking response, the MAP increasing from below 70 mmHg to more than 80 mmHg for the first time since admission (aside from the boluses given at 5 hours), but even more striking was the change in urine output which increased dramatically (Figure 5).