Dynamic study of plasma protein leakage in multiple organs during endotoxic shock as monitored with a double isotope technique

Endotoxemia and sepsis are frequently accompanied by generalized edema due to increased vascular permeability to plasma proteins. For 4 h we have continuously followed changes in the plasma protein index in the lungs, liver, intestine and kidneys in a clinically relevant model of endotoxic shock in sheep. A double-isotope technique was used and the radioactivity was recorded by a computerized gamma camera. The transferrin index (TI), describing plasma extravasation, was calculated for each organ studied. Seven sheep were infused with Escherichia coli endotoxin and 7 received normal saline (controls). The endotoxin infusion caused characteristic hemodynamic and respiratory changes, but it also resulted in an immediate increase in both lung and liver TI, while no significant changes were recorded in the controls (p < 0.01). No significant TI changes were recorded in the kidneys or in the intestine. It was concluded that endotoxemia causes a marked rise in plasma protein index both in the lungs and the liver shortly after the administration of endotoxin. This supports previous data indicating that the liver may be affected just as early as the lungs during endotoxemia.