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Open AccessArticle

Norepinephrine Leads to More Cardiopulmonary Toxicities than Epinephrine by Catecholamine Overdose in Rats

1
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
2
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
3
Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
4
Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
5
Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
6
Department of Cardiology, Kaohsiung Municipal United Hospital, Kaohsiung 804, Taiwan
7
School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
8
Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
*
Author to whom correspondence should be addressed.
Toxics 2020, 8(3), 69; https://doi.org/10.3390/toxics8030069
Received: 13 August 2020 / Revised: 11 September 2020 / Accepted: 13 September 2020 / Published: 16 September 2020
(This article belongs to the Section Toxicology and Public Health)
While catecholamines like epinephrine (E) and norepinephrine (NE) are commonly used in emergency medicine, limited studies have discussed the harm of exogenously induced catecholamine overdose. We investigated the possible toxic effects of excessive catecholamine administration on cardiopulmonary function and structure via continuous 6 h intravenous injection of E and/or NE in rats. Heart rate, echocardiography, and ventricular pressure were measured throughout administration. Cardiopulmonary structure was also assessed by examining heart and lung tissue. Consecutive catecholamine injections induced severe tachycardia. Echocardiography results showed NE caused worse dysfunction than E. Simultaneously, both E and NE led to higher expression of Troponin T and connexin43 in the whole ventricles, which increased further with E+NE administration. The NE and E+NE groups showed severe pulmonary edema while all catecholamine-administering groups demonstrated reduced expression of receptor for advanced glycation end products and increased connexin43 levels in lung tissue. The right ventricle was more vulnerable to catecholamine overdose than the left. Rats injected with NE had a lower survival rate than those injected with E within 6 h. Catecholamine overdose induces acute lung injuries and ventricular cardiomyopathy, and E+NE is associated with a more severe outcome. The similarities of the results between the NE and E+NE groups may indicate a predominant role of NE in determining the overall cardiopulmonary damage. The results provide important clinical insights into the pathogenesis of catecholamine storm. View Full-Text
Keywords: norepinephrine; epinephrine; catecholamine overdose; ventricular dysfunction; lung injuries norepinephrine; epinephrine; catecholamine overdose; ventricular dysfunction; lung injuries
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MDPI and ACS Style

Lu, W.-H.; Chen, H.-H.; Chen, B.-H.; Lee, J.-C.; Lai, C.-C.; Li, C.-H.; Tseng, C.-J. Norepinephrine Leads to More Cardiopulmonary Toxicities than Epinephrine by Catecholamine Overdose in Rats. Toxics 2020, 8, 69.

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