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Dopamine
Aka: Dopamine, Intropin, Dopamine Hydrochloride- Mechanism
- Low dose (2-5 ug/kg/min)
- Increases splanchnic flow
- Increases coronary perfusion
- Increases cerebral flow
- Increases renal perfusion
- Previously recommended for oliguric Renal Failure
- No longer recommended due to lack of GFR effect
- Mid-dose (5-10 ug/kg/min)
- Direct Beta Adrenergic Receptor effects
- Increases cardiac contractility
- No effect on Blood Pressure
- No effect on Heart Rate
- Stimulates Norepinephrine release
- Effect blunted if Norepinephrine stores depleted
- Direct Beta Adrenergic Receptor effects
- High Dose (10-20 ug/kg/min)
- Increase in Blood Pressure
- Tachycardia may be significant problem
- Vasoconstriction of renal and splanchnic beds
- Half life of Dopamine is short and requires infusion
- Low dose (2-5 ug/kg/min)
- Indications
- Hemodynamically significant Hypotension
- Systolic Blood Pressure under 90 mmHg
- Poor Tissue perfusion
- No hypovolemia
- Hypotension following Resuscitation
- Hemodynamically significant Hypotension
- Contraindications: Absolute
- Contraindications: Relative (or use low dose Dopamine)
- Increased vascular resistance
- Pulmonary congestion or Congestive Heart Failure
- Increased Preload
- Precautions
- Dopamine has been largely replaced by Norepinephrine in adults in U.S.
- Theoretically safer than Norepinephrine when used peripherally
- However Norepinephrine is often initially used via a reliable peripheral IV safely
- Theoretically with greater renal protection than other Vasopressors
- Does not appear to offer any significant benefit over other Vasopressors in renal protection
- Theoretically safer than Norepinephrine when used peripherally
- In children, Dopamine is still a first-line Vasopressor despite risks
- See the adverse effects (e.g. Dysrhythmia) below
- Dopamine is asssociated with a three fold increased mortality in septic children
- Dopamine has been largely replaced by Norepinephrine in adults in U.S.
- Dosing: Pediatric Infusion (Same as Dobutamine preparation)
- Preparation
- Draw up "x" mg of Dopamine
- Where "x" = 6 x Weight in Kilograms
- Add enough D5W or NS to Dopamine for 100 ml total
- At this dilution
- Infusion rate of 1 ml/h provides 1.0 ug/kg/min
- Start Dose: 10 ug/kg/min or 10 ml/hour
- Titrate to effect
- Perfusion
- Urine Output
- Blood Pressure
- Preparation
- Dosing: Adult Infusion
- Preparation
- Start with 1-2 ampules Dopamine (400 mg each)
- Dissolve 400-800 mg Dopamine in 250 ml D5W
- Final Concentration: 1600-3200 ug/ml
- Start Dose: 1-5 ug/kg/min
- Titrate: 5-20 ug/kg/min to clinical response
- Perfusion
- Urine Output
- Blood Pressure
- Preparation
- Adverse Effects
- Tachycardia
- Increases myocardial oxygen demand
- Arrhythmias
- Hypertensive Crisis
- Increases Pulmonary artery wedge pressure
- May worsen pulmonary congestion
- May provoke Congestive Heart Failure
- Gastrointestinal
- Tachycardia
- Precautions
- Avoid Dopamine dose over 20 ug/kg/min
- Results in severe Vasoconstriction and ischemia
- Consider adding Norepinephrine if inadequate BP
- Use caution with Dopamine in Congestive Heart Failure
- Consider adding Vasodilator
- Consider using Dobutamine instead of Dopamine
- Taper Dopamine gradually to avoid Hypotension
- Use Dopamine via central venous catheter
- Extravasation causes severe local tissue damage
- Antidote for extravasation
- Phentolamine 5-10 mg diluted in 10-15 ml NS
- Infiltrate area of extravasation with Phentolamine
- Avoid Dopamine dose over 20 ug/kg/min
-
Drug Interactions
- Sodium Bicarbonate inactivates Dopamine
- Also occurs with Epinephrine
- Monoamine Oxidase Inhibitors potentiate Dopamine effect
- Use only one tenth of regular dose
- Bretylium effects may be synergistic with Dopamine
- Phenytoin may cause Hypotension with Dopamine
- Sodium Bicarbonate inactivates Dopamine
- References
- Goldberg (2015) Crit Dec Emerg Med 29(3): 9-19
- McCollum in Herbert (2019) EM:Rap 19(7):4-6