Increased body fluid purine levels during hypotensive events. Evidence for ATP degradation.

Tissue ischemia leads to adenosine triphosphate (ATP) breakdown with elevation of body fluid ATP metabolites. This study tests the hypothesis that there is a direct relationship between periods of hypotension and body fluid uric acid and oxypurine levels in 19 prospectively studied patients. Significant elevations in urine oxypurine/creatinine clearance were found during periods of hypotension as compared with nonhypotensive periods (p less than 0.05). During severe episodes of hypotension, the serum urate level was significantly elevated as well (p less than 0.05). The increase in these body fluid products of ATP degradation may reflect cellular ischemia during hypotensive periods. There was a weak correlation (r = -0.31, p less than 0.001) between the systolic blood pressure and urine oxypurine/creatinine clearance. However, variability in the appearance of body fluid ATP breakdown products during episodes of hypotension suggests the interplay of multiple factors in the degradation of ATP. The use of ATP degradation products to quantitate the physiologic significance of clinical events remains tantalizing but not proved.