II. Indications

  1. Septic Shock or other Distributive Shock
    1. Adjunct to other management (Intravenous Fluids, Vasopressors)

III. Pharmacology

  1. See Angiotensin for mechanism
  2. Angiotensin 2 increases Blood Pressure

IV. Dosing: Adults

  1. Initial
    1. Start 20 ng/kg/min
    2. Titrate in 5 to 15 ng/kg/min increments every 5 min for Blood Pressure response
    3. Maximum: 80 ng/kg/min in first 3 hours of management
  2. Maintenance
    1. Titrate in 5 to 15 ng/kg/min increments down every 5 to 15 min
    2. Maximum: 40 ng/kg/min
    3. Lowest effective dose: 1.25 ng/kg/min

V. Adverse Effects

  1. Venous Thromboembolism (e.g. DVT, PE)
    1. Most common adverse effect (>10% Incidence)
  2. Thrombocytopenia
  3. Tachycardia
  4. Fungal infection
  5. Delirium
  6. Acidosis
  7. Hyperglycemia
  8. Peripheral ischemia

VI. Drug Interactions

  1. ACE Inhibitors
    1. Increase response to Angiotensin 2
  2. Angiotensin Receptor Blockers (ARB)
    1. Decrease response to Angiotensin 2

VII. References

  1. LoVecchio (2018) Crit Dec Emerg Med 32(7): 28

Images: Related links to external sites (from Bing)

Related Studies