Max Norepi dosing
Started by Fastrach
one of my attendings says "the max is 999 on the pump." although I don't think he has literature to support that.
I sort of subscribe to that philosophy. No max dose as far as I'm concerned. I'll usually add vasopressin when I get to 15 mcg a minute or so.
Agree with no maximum limit.
If it's not working at a certain dose then increasing the dose is either going to improve it's effect or just do nothing.
When increasing the dose stops making meaningful changes in SVR then it is time to consider adding something like Vasopressin provided that you have already optimized the volume status and the cardiac output.
If it's not working at a certain dose then increasing the dose is either going to improve it's effect or just do nothing.
When increasing the dose stops making meaningful changes in SVR then it is time to consider adding something like Vasopressin provided that you have already optimized the volume status and the cardiac output.
probably wouldn't go over 20 mics per minute.
Why not?
There was a recent M&M, that was released into the public domain by the department involved, in which a 12-year-old received at least a 1 mg IV bolus of NE (potentially a 4 mg bolus.) Her pressure got into the 150's, pulse into the mid 40s, and she got a headache.
That certainly supports the contention that there is no effect beyond a certain point.
- pod
That certainly supports the contention that there is no effect beyond a certain point.
- pod
Agree. Ceiling effect? All the receptors occupied....???
Max dose of vassopressin?
There isn't such a number.
I know what the textbook says.
See the dog studies.
2win
l think it seriously vasoconstricts guts beyond this dose, please correct me if l am wrong. How much does estimate for lasting of infusion has impact on max dose of NA?
The highest I've ever done 500 mcg/min to keep the lady alive until her family got there to say goodbye. Probably pod is right, after you've saturated all your adrenergic receptors you won't get any more effect.
I remember during residency doing an "emergent" organ procurement. The patient comes flying around the corner into the OR so the transplant guys could take some organs. The BP was hovering around the 60-70s SBP and the ICU nurse was trying to give me some kind of report about the escalating doses of Vaso and levo. I just took them off the pump and started dripping them in, and titrating to effect. I liked seeing 110 a lot better, up until the inevitable exsanguination.
If the patient is in shock and not responding to NE this probably means that NE is unable to produce any meaningful vasoconstriction anywhere including the intestine.
