Some patients in shock may fail to respond to high doses of infused catecholamines.

Synonyms: vasopressor-resistance, vasoplegia, vasoplegic shock


Catecholamine-resistant shock involves persistent hypotension despite appropriate delivery of maximum doses of catecholamines. It is important to confirm that the type and dose of vasopressor is appropriate.

Conditions associated with catecholamine-resistant shock:

(1) massive blood loss (which may be occult)

(2) anaphylaxis

(3) sepsis

(4) adrenal insufficiency

(5) vasopressin deficiency

(6) severe lactic acidosis

(7) cardiac surgery

(8) liver transplantation

(9) cardiogenic shock


Possible causes of failure to respond to catecholamines (Gamcrlidze et al)"

(1) nitric oxide overproduction

(2) prostacyclin (PG12)

(3) vasopressin deficiency

(4) elevated serum endothelin

(5) elevated serum adrenomedulin

(6) elevated serum calcitonin gene-related peptide

(7) endothelial dysfunction

(8) oxidation of catecholamines

(9) over activation of ATP-sensitive potassium channels

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