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Methylene blue for distributive shock: a potential new use of an old antidote
David H Jang1, Lewis S Nelson, Robert S Hoffman
1Division of Medical Toxicology, Department of Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, 455 First Avenue, Room 123, New York, NY, 10016, USA, Jangd01@nyumc.org.
Abstract:
Methylene blue is used primarily in the treatment of patients with methemoglobinemia. Most recently, methylene blue has been used as a treatment for refractory distributive shock from a variety of causes such as sepsis and anaphylaxis. Many studies suggest that the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway plays a significant role in the pathophysiology of distributive shock. There are some experimental and clinical experiences with the use of methylene blue as a selective inhibitor of the NO-cGMP pathway. Methylene blue may play a role in the treatment of distributive shock when standard treatment fails.
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