Noradrenaline and adrenaline concentrations in various vascular beds in patients with cirrhosis Relation to haemodynamics.

Summary. Plasma noradrenaline (NA) and adrenaline (A) concentrations were related to various haemodynamic parameters in fifteen patients with cirrhosis. In supine position at rest plasma NA and A in peripheral venous blood were significantly higher in patients with cirrhosis than in normal subjects. Mean plasma NA averaged 0–66 and 0–21 ng/ml, respectively ( P <0–01). The corresponding values for plasma A were 0–14 and 005 ng/ml ( P <0 03). Splanchnic arterial‐hepatic venous extraction ratio of NA in patients with cirrhosis averaged 0–46 ( P <0–01). The right kidney released NA into the systemic circulation. Renal venous plasma NA exceeded arterial concentration by 38% ( P <0–01). NA concentrations in femoral vein and ascitic fluid were not different from that of arterial plasma. Plasma NA was positively correlated to wedged hepatic vein pressure (r = 0–86, P <0–001) and to heart rate ( r = 0–61, P <002), but inversely correlated to plasma volume ( r =–0–83, P <0–01) in cirrhotic patients. Arterial blood pressure was reduced in these patients compared to controls ( P <0–02), but not significantly correlated to plasma NA. The increased plasma NA indicates that sympathetic nervous activity is enhanced in patients with cirrhosis. Based on the above positive correlation between NA and heart rate and the significant release of NA from the kidney, it may be hypothesized that the increased sympathetic nervous activity especially involves heart and kidney. This response may be mediated by baro‐ and volume receptors.