The effect of glutathione and N-acetylcysteine on lipoperoxidative damage in patients with early septic shock

Both the hyperproduction of oxygen free radicals (OFR) and the weakening of natural scavenging mechanisms have been implicated as contributors to mult iple organ failure in septic shock. This study examined whether the antioxi dants glutathione (GSH) and N-acetyl-L-cysteine (NAC) play a protective rol e against damage by OFR in early septic shock. We randomly entered 30 patie nts with septic shock into one of three groups within 24 h of diagnosis. Ai l of the patients received septic: shock therapy, including parenteral nutr ition, antibiotics, and volume-expanding and inotropic agents. One group (G roup B) also received 70 mg/kg/d of intravenous GSH, and a second group (Cr oup C), 70 mg/kg/d of intravenous GSH and 75 mg/kg/d of intravenous NAG. Th e protection against OFR damage was evaluated by measuring expired ethane, plasma malondialdehyde, erythrocyte deformability, complement activation, a nd clinical scores at admission and on Days 3 and 5 of treatment. A signifi cant decrease in peroxidative indexes was observed at Day 5 in Group B as c ompared with both the control group and basal values. The decrease in perox idative indexes was even more marked in Group C. Clinical scores in this gr oup were also significantly improved. In conclusion, the administration of high doses of NAC added to GSH significantly decreased the peroxidative str ess of patients with septic shock.