Influence of dopamine on the liver assessed by changes in arterial ketone body ratio in brain-dead dogs.

The influence of dopamine on liver metabolism in the state of brain death was assessed by measuring arterial ketone body ratio (AKBR) in dogs. Mean arterial blood pressure (MABP) was significantly decreased, from 137.4 +/- 3.7 to 64.7 +/- 2.8 mm Hg, 1 hour after completion of brain death (p less than 0.01). In the control group AKBR was maintained at the near control value of 1.07 thereafter, concomitant with a significant decrease in serum lactate levels, despite marked hypotension (p less than 0.05). Dopamine infusion at rates of 5 and 10 micrograms/kg/min sustained both AKBR and MABP at near control values. In contrast, dopamine given at doses greater than 15 micrograms/kg/min caused a significant reduction of AKBR, to less than 0.66 +/- 0.12 (p less than 0.01), although MABP was restored to near-normal levels. In addition, serum levels of alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase were significantly elevated, reflecting liver cell injury. It is suggested that the liver is primarily tolerant to hypotension in the state of brain death and that dopamine administered at a rate of 15 micrograms/kg/min or more impairs liver metabolism by reducing the redox state (free nicotinamide-adenine dinucleotide/reduced nicotinamide-adenine dinucleotide) of liver mitochondria.