• B Krafte-Jacobs, R Brilli, C Szabó, A Denenberg, L Moore, and A L Salzman.
• Division of Critical Care Medicine, Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
• Crit. Care Med. 1997 Sep 1;25(9):1588-93.

ObjectivesTo examine the relationship between circulating methemoglobin and nitrite/nitrate concentrations and to compare these markers of nitric oxide overproduction with clinical variables in children diagnosed with septic shock.DesignProspective, controlled, clinical study.SettingPediatric intensive care unit and outpatient clinic in a children's hospital.PatientsTwenty-two children diagnosed with septic shock and ten age-matched healthy control patients.InterventionsPatients diagnosed with septic shock had blood specimens taken on study entry and every 6 hrs for 72 hrs for methemoglobin and nitrite/nitrate determinations. Single blood specimens were obtained from controls.Measurements And Main ResultsCirculating methemoglobin and nitrite/nitrate concentrations were significantly higher in children diagnosed with septic shock in comparison with healthy control children (p = .01 and .05, respectively). Peak nitrite/nitrate concentrations correlated with serum creatinine (r2 = .19; p = .04) and were inversely correlated with arterial pH (r2 = .28; p = .01) and urine output (r2 = .21; p = .03) when analyzed by log-linear regression. There were no significant relationships between methemoglobin and nitrite/nitrate or between methemoglobin and any other clinical variable.ConclusionsCirculating methemoglobin and nitrite/nitrate concentrations are increased in children diagnosed with septic shock. Plasma nitrite/nitrate values correlate with selected clinical variables in these children. Circulating methemoglobin measurements are not superior to plasma nitrite/nitrate concentrations as an indicator of endogenous overproduction of nitric oxide in children diagnosed with septic shock. A need remains to develop markers of endogenous nitric oxide activity that have greater accuracy and reliability.

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