DOPAMINE

1. Indications
   1. Cardiogenic shock
   2. Septic or neurogenic shock when unresponsive to other measures

2. Contraindications
   1. Uncorrected tachyarrhythmias
   2. Hypovolemic shock

3. Administration
   1. Mix: 400 mg in 250 ml of NS or 800 mg in 500 ml NS to produce a concentration of 1600 mcg/ml.
   INTRAVENOUS DRIP RATES FOR DOPAMINE
   Concentration: 1600 mcg/kg/ml | All doses in mgtts/min

   Weight (kg)	5 (mcg/kg/min)	10 (mcg/kg/min)	15 (mcg/kg/min)	20 (mcg/kg/min)
   50	10	20	30	40
   60	10	25	35	45
   70	15	25	40	50
   80	15	30	45	60
   90	15	35	50	70
   100	20	35	55	75
   110	20	40	60	85

4. Precautions
   1. Pressor agents worsen tissue hypoxia in the presence of hypovolemia from diuretics and poor intake; careful differentiation is necessary.
   2. Dopamine is best administered by an infusion pump to accurately regulate rate.
   3. Dopamine may induce tachy-dysrhythmias. If the heart rate exceeds 140, the infusion should be stopped.
   4. At low doses, decreased blood pressure may occur due to peripheral vasodilation. Increasing infusion rate will correct this.
   5. Should not be added to sodium bicarbonate or other alkaline solutions, since dopamine will be inactivated at higher pH.
   6. Tissue extravasion at the IV site can cause skin sloughing due to vasoconstriction. Be sure to make Emergency Department aware if there has been any extravasation of dopamine-containing solutions, so that proper treatment can be instituted.
   7. Can cause hypertensive crisis in susceptible individuals.
   8. Certain antidepressants potentiate the effect of this drug. Check for medications and if other medications are being used.

5. Pharmacology and Actions
   1. Dopamine is a chemical precursor of epinephrine. It occurs naturally in humans
   2. Dopamine has the following dose related effects.
      1. 1-2 mcg/kg/min: dilates renal and mesenteric blood vessels (no effect on heart rate or blood pressure).
      2. 2-10 mcg/kg/min: beta effects on heart usually increase cardiac output without increasing heart rate.
      3. 10-20 mcg/kg/min: alpha peripheral effects cause peripheral vasoconstriction and increased blood pressure.
      4. 20-40 mcg/kg/min: alpha effects reverse dilatation of renal and mesenteric vessels with resultant decreased flow.