II. Indications
-
Septic Shock or other Distributive Shock
- Adjunct to other management (Intravenous Fluids, Vasopressors)
III. Pharmacology
- See Angiotensin for mechanism
- Angiotensin 2 increases Blood Pressure
- Half-Life: <1 minute
- Peak Effect: 5 minutes
- Metabolized by aminopeptidase A and Angiotensin Converting Enzyme 2 and 3
IV. Dosing: Adults
- Initial
- Start 20 ng/kg/min
- Titrate in 5 to 15 ng/kg/min increments every 5 min for Blood Pressure response
- Maximum: 80 ng/kg/min in first 3 hours of management
- Maintenance
- Titrate in 5 to 15 ng/kg/min increments down every 5 to 15 min
- Maximum: 40 ng/kg/min
- Lowest effective dose: 1.25 ng/kg/min
V. Adverse Effects
-
Venous Thromboembolism (e.g. DVT, PE)
- Most common adverse effect (>10% Incidence)
- Thrombocytopenia
- Tachycardia
- Fungal infection
- Delirium
- Acidosis
- Hyperglycemia
- Peripheral ischemia
VI. Drug Interactions
-
ACE Inhibitors
- Increase response to Angiotensin 2
-
Angiotensin Receptor Blockers (ARB)
- Decrease response to Angiotensin 2
VII. References
- LoVecchio (2018) Crit Dec Emerg Med 32(7): 28
- LoVecchio (2022) Crit Dec Emerg Med 36(7): 32