Dopamine Infusion


Oct 9, '06I am not sure what yoiu are asking, our Dopamine comes premixed. 400mg Dopamine in a 250 bag of NS or D5. Is that what you needed?

Oct 10, '06It comes in 200mg/5ml vial. We used to make it up (for ease) as 600mg in 100ml D5W. That meant that each 1ml/hr = 100mcg/min. [or modify to 300mg in 50ml syringe]
600mg/100ml = 6mg/ml = 6000 mcg/ml
1 ml/hr = 6000/60 = 100 ml/min
Then we'd usually run it at 100  500 mcg/minLast edit by augigi on Oct 10, '06 
Oct 10, '06I guess I am trying to understand the mcg of a drug, how much it is worth compared to mg.
I have to see in my policy and procedure of Dopamine infusion online as they have a format that is based according to patients weight so that every hour whether to see patients BP is stable as well as what to set the infusion machine at hourly according to mcg/kg/min, when weaning patient off? 
Oct 11, '06Sorry Kylie, I don't understand your question.
1mg = 1000 mcg.
Some units use mcg/kg/min, some use mcg/min for ease, since the kg doesn't tend to change.
In the concentration I described, we generally ran it at about 5ml/hr = 300mcg/min. ie. that means that for a patient weighing 75 kg, the dose would be 300/75 = 4 mcg/kg/min.
If it was running at that rate, and then the doc wanted to increase it to 5 mcg/kg/min for BP control, you'd work out that should be 5 x 75 = 375mcg/min. So you'd increase from 3ml/hr to 3.75 ml/hr.
Does that make sense? As I said, I don't really understand what you're asking. 
Oct 17, '06Jeepers creepers! On my tele floor we run UP to 7.5 mcg/kg/min. That's it! The rates you guys have been quoting sound like a good ticket to the Eternal Care Unit from where I'm sitting! I about get heart palpitations just thinking about it.

Oct 17, '06Quote from IndyThe quote above was in mcg/min NOT mcg/kg/min.Jeepers creepers! On my tele floor we run UP to 7.5 mcg/kg/min. That's it! The rates you guys have been quoting sound like a good ticket to the Eternal Care Unit from where I'm sitting! I about get heart palpitations just thinking about it.
We use standard 400mg/250D5W bags. That equates to 1.6mg/ml or 1600 mcg/ml.
1600mcg/60 min = 26.6 mcg/min.
Now, divide into THAT wt in kg and you have a constant you can use.
For example, if pt were say, 53.5 kg, that would give you a constant of about 0.5 mcg/kg/min at 1 ml/hr.
Or 1600 mcg/60min/53.5 kg = 0.5
So, if your rate is 6mls/hr on the pump, then your dose is 6*0.5 or 3 mcg/kg/min.
Or, if you want to run at 3mcg/kg/min then 3/0.5 = 6 ml/hr.
For the standard bag, 26.6/kg in wt gives you a constant to work from. The 26.6 is standard to the bag, and you can start your math from there.
Easy. The key to understanding this is to put out of your mind that this is some complicated math formula. It isn't.
~faith,
Timothy.Last edit by ZASHAGALKA on Oct 17, '06 
Oct 18, '06I guess I am trying to understand the equivalence of how much Dopamine in MCG related to mls.
For instance, curious to know how many mcg can be potent or dangerous?
I dont know how else to explain my confusion
:uhoh21: 
Oct 18, '06Quote from RNKylieDepends on the situation, and the weight of the person. The first thing to consider, and this isn't considered widely enough, is that before moving to a pressor, volume replacement is the first consideration. It does no positive good to squeeze down on volume that isn't there.I guess I am trying to understand the equivalence of how much Dopamine in MCG related to mls.
For instance, curious to know how many mcg can be potent or dangerous?
I dont know how else to explain my confusion
:uhoh21:
When it comes to pressure rescue, barring contraindications (left sided heart failure, cardiogenic shock), and many times, even considering them, the key is: volume volume volume.
Generally, 10mcg/kg/min would be the highest normal dose for a pt without calling MD. At that point, we normally begin to consider adding something else for pressure support.
So, for a 100kg (~220 lb) person and using my math above:
26.6/100 = .266 or .27 (I normally round here).
If you want to know the mls/hr rate for 10mcg that would be 10/.27 = 37 ml/hr. If a person is larger, that rate would be higher, if a person weighs less, that number would be smaller.
Now, in a dire situation, life or death correction needed now, we normally go up as high as 20mcg/kg/min or about 70ml hr for this 220 lb person. Any more than that is typically, based on my anecdotal experience, refractory  there is no more benefit. As far as the dose being potent or dangerous, if we are playing with doses this high on someone, the situation is ALREADY dire, regardless how much dopamine is running. I've seen codes where it is run wide open. Again, my experience is that at some point, the system becomes refractory to responding to high high doses, and the drug would need to be used in conjunction with other treatments.
Now, if you want to know the same thing for a 110 lb person, the kgs would be half and I could do the math, but it would be half: ~19ml/hr = 10mcg/kg/min and about 37ml/hr = a very high dose: 20mcg/kg/min.
I will say this, in my neck of the woods, dopamine was the 'gold standard' for years. But, levophed has made a comeback. Levophed is not just 'leave 'em dead' (used last ditch) anymore.
~faith,
Timothy.Last edit by ZASHAGALKA on Oct 18, '06 
Oct 18, '06Hello
At my place we run Dopamine mcg/kg/min...Our max is 20 mcg/kg/min. We usually titrate up and add another agent for blood pressure support at around 15 mcg (of course every patient is individualized), other vasoactive meds we commonly use are...neosynephrine, levophed, vasopressin and epinephrine.
If we have to add multiple agents to sustain a Mean Arterial Pressure of 60 then we place a swan so we can optimize the patient with additional meds.
I've seen a change over recent years with pressors...dopa seemed to be first line for hypotension and the 2 hospitals I work at now seem to go to levophed first which was a last line drug that earned the nickname "leave 'em dead". Anyone else seen a trend?
LCRN 

Oct 22, '06Well just to say this for a fact, I have never given out the drug ever and another thing is I am learning. So if you cant help a person out to understand, then dont reply back simple as that. I am trying to get a basic understanding as we run these drugs on the ward so I am just curious to know.
So cut me some slack. Until I do it then it might make sense to me. 
Oct 22, '06got a great resource for you! have you visited our colleague mike
hammerschmidt's website: http://www.icufaqs.org/
he's got several articles that are just what you need to jumpstart a ccu/icu career:
pacemakers 12/04
pressors and vasoactives[color=#ff3366] 11/05
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