Metabolic Effects of Norepinephrine and Dobutamine in Healthy Volunteers

Abstract

The objective of the present study was to evaluate the effects of norepinephrine (n = 9) and dobutamine (n = 7) on carbohydrate and protein metabolism in healthy volunteers in comparison with a control group (n = 9). Norepinephrine (0.1 microg/kg min), dobutamine (5 microg/kg min), or placebo was infused for 240 min. The plasma concentration of glucose, lactate, epinephrine, norepinephrine, insulin, and glucagon were determined. Glucose and urea production and leucine flux were measured using a tracer technique. Norepinephrine caused a persisting rise in plasma glucose concentration, whereas the increase in glucose production was only transient. A minor increase in plasma lactate concentration was observed, but it did not exceed the physiological range. No change in leucine flux, urea production, or plasma concentration of insulin, glucagon, or epinephrine was found. Dobutamine slightly decreased glucose production, whereas the plasma concentration of glucose and lactate did not change. The reduction in leucine flux was paralleled by a decrease in urea production. No change in the plasma concentration of insulin, glucagon, or the catecholamines was observed. In conclusion, both norepinephrine and dobutamine have only minor metabolic effects. Because glucose production is enhanced by alpha1- and beta2-adrenoceptor stimulation, we conclude that dobutamine is only a weak agonist at these adrenoceptors. These minor metabolic actions may make both compounds suitable for critically ill patients because no further increase in metabolic rate should be caused.

Metabolic effects of three different inotropic strategies in the newborn piglet myocardium

“…This has been demonstrated in both healthy volunteers and in patients in shock of various aetiologies including cardiogenic shock and after cardiac surgery . In agreement with our results, previous studies demonstrated no change in the arterial lactate concentration by administration of intravenous dobutamine or dopamine in adult healthy volunteers and patients . In contrast to our results, an observational study by Li et al.…”

“…Dopamine has limited effects on the β 2 ‐adrenoceptors and little effect on the global metabolism. Even though dobutamine does affect the β 2 ‐adrenoceptors mediating vasodilator properties, dobutamine does not seem to have the same effect on the global metabolism as adrenaline . The observed increase in arterial lactate in the milrinone–adrenaline group, in our study, thus may arise from the β 2 ‐adrenergic stimulation of aerobic glycolysis in the skeletal muscle.…”

The adrenergic coin: perfusion and metabolism

“…First, the authors confirm the well known effect of epinephrine (in contrast to norepinehrine) of increasing glucose and lactate levels in animal models [10,11,12,13] as well as in humans [14,15,16] in controls. The endotoxin challenge in the present model was associated with decreased mean arterial pressure and systemic blood flow.…”

Lactate and glucose metabolism in severe sepsis and cardiogenic shock*

“…Besides inflammatory mediators and counter-regulatory response, the adrenergic agonists administered for cardiovascular therapy (Table 1) may have contributed to glycolysis and increased lactate production. The effect of these agents could not be assessed directly in these severely ill patients but are measurable in healthy subjects (23). The very high insulin concentrations observed are consistent with a marked state of insulin resistance (Fig.…”