Serum
octopamine levels were significantly higher in twenty patients with
fulminant hepatic failure (FHF) during the first 48 h of grade IV
coma than in health control subjects (3.38 +/- 0.20 ng/ml and 1.75 +/- 0.19 ng/ml respectively, P less than 0.001). Serial measurements in five patients who died without regaining consciousness showed serum
octopamine to remain raised, and concentrations in the cerebrospinal fluid at death reflected serum levels. In five patients who regained consciousness, improvement in
encephalopathy was associated with a significant reduction in serum
octopamine.
Renal failure in patients with FHF was found to contribute to raised serum
octopamine but could not alone account for the observed levels. Patients given
neomycin therapy did not have significantly lower serum
octopamine levels than an untreated group. There was, however, a significant correlation between elevated serum
octopamine and the occurrence of gestrointestinal
bleeding during the previous 24 h.
Charcoal haemoperfusion did not appreciably reduce serum
octopamine levels.