The elevated catecholamine levels in cirrhotic patienta with ascites have been propaeed to be due to sympathetic overactivity secondary either to reduced intraveocular volume or to an underlying cardiovascular abnormality such as reduced pressor responsiveness. Furthermore, these elevated catecholamine levels have been proposed to be involved in the pathogenesis of salt and water retention. Therefore, the effect of peritoneo-~8801111 shunting on the circulating levels and renal excretion of catecholamiges were studied in six patients with lllllseive refractive ascites preoperative within the firtat 8 hr poetoperative and by 2 weeks postoperative under metabolic conditions. The recirculation of ascites into the intravascular compartment resulted perioperatively in significant rises in cardiac output (p = 0.001), para-amino-hippurate clearance (p = 0.08), creatinine clearancet, diuresis (p = 0.06) and natriuresis (p = 0.06).
SyetemiC blood pressure remained unchanged while systemic vnscular resistance decreased (p < 0.05).
Preoperative circulating levels of free catecholamine were highly elevated, and renal vein concentrations were about 25% higher than renal arterial levels. Perioperatively, there was little change in circulating catecholamine levels or distribution of renal blood flow al- tho-renal artery and vein concentrations tended to equalize.
In contrast by 2 weeke postoperatively, free catecholamine levels had fallen to within the normal ranges: mean norepinephrine from 1,477.6 f 194.6 to 395 f 62.9 pg per ml (p < 0.06); epinephrine from 276 f 74.2 to 65.7 f 16.0 pg per ml (p < 0.02), and dopamine from 325.6 f 175.2 to 47.9 f 6.3 pg per ml. There was little change in circulating conjugated catecholamine levels, either urinary excretion or clearance of cateeholamines, except epineplwhe clearance which rose significantly (p < 0.05). Despite the normalization of circulating free catechdamine levels, the patients tended to remain hypotemdve with a low peripheral vascular resistance. The retarn of circulating free catecholamine levels to normal following reexpansion of the intravascular volume by peritoneovenous shunting are in favor of their being elevated in reeponse to vascular underfilling.