Correct!
1. Converted in the liver to bicarbonate ion

Acetate is converted in the liver to bicarbonate (2). Mean arterial pressures remained in the low 50’s despite maximal vasopressor support and acidosis was unchanged. A bolus of methylene blue (2mg/kg) was administered with modest improvement in blood pressure (3).

What is the mechanism of action of methylene blue to improve shock? (Click on the correct answer to proceed to the fourth and last page)

1. Direct vasoconstriction of arterioles
2. Increases synaptic release of norepinephrine
3. Inhibition of nitric oxide synthetase, and nitric oxide production
4. Tyrosine kinase inhibition

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