Role of desmopressin in the treatment of a case of septic shock refractory to catecholamines.

The authors describe a case of septic shock refractory to high-dose catecholamines after adequate volemic filling, rapidly corrected with the administration of desmopressin at a dose of 0.02 U/min. There are, in the literature, several cases of septic shock refractory to high-dose catecholamines successfully treated with arginine-vasopressin, a selective V1 agonist. This agent can potentially induce coronary vasoconstriction and presents a very difficult weaning, that imposes a slow reduction of the infusion amount. On the contrary, desmopressin does not present those adverse effects and is able to maintain a high renal blood flow, for its prevalent action on V2 instead of V1 receptors.