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Methylene Blue Use for Refractory Hypotension in Setting of Necrotizing Pancreatitis
Methylene blue is controversially used in the management of refractory vasoplegia and septic shock due to its mechanism of inhibiting guanylate cyclase and decreasing cGMP levels to improve vascular tone. In recent meta-analysis, methylene blue use in septic shock resulted in improvement of hypotension, blood pressure, and cardiac function, while significantly reducing mortality and ICU/hospital stays. Further usage of methylene blue may benefit anaphylactic and drug-induced shock by reducing vasopressor requirements. Administered intravenously, methylene blue peaks at 30 minutes, with effects lasting 48–72 hours, making it a valuable treatment for various shock conditions.