Effect of Nitric Oxide on Renal Function in Septic Shock

To the Editor: Nitric oxide is a central mediator in septic shock because of its ability to relax smooth-muscle cells in arterial walls1. High levels of nitrate, one of the metabolites of nitric oxide, can be found in the serum of hypotensive patients with sepsis2,3. Several important features of nitric oxide in septic shock are illustrated by the case of a liver-transplant recipient who had two episodes of septic shock due to gram-negative bacteria, during which we measured blood concentrations of endotoxin, cytokines, and metabolites of nitric oxide (Table 1). A bout of septicemia due to Escherichia . . .