Re: Natracor and low bp Originally Posted by ark-two About the albumin/lasix- how does that work, are they mixed together and given in gtt form?
We don't use an albumin/lasix gtt. Our common dose is 250 of albumisol with 20mg of lasix it's called a "cocktail" where I work. We just draw up the lasix and put it in the albumisol bottle and run free flowing through tubing at the desired rate. It's great for a patient like this who is fluid overloaded, but may be intravascularly dry. The high heart rate could be your dopamine, or it could be that the patient is dry in the vascular space from third spacing out. Did he have a lot of edema?
Also, your UOP could be caused from several different factors. He could be in renal failure from being dehydrated, or more likely from hypoperfusion related to the hypotension. Also, at 80 years old, his baseline renal function was probably not that great and he could have just taken a small hit to his kidneys for whatever reason (medications, infection, dehydration, low bp) and caused big time problems. With such a low EF, I would guess his cardiac output was just not strong enough to perfuse his vital organs, including his kidneys.
Also, I would not think Cardiazem is a good choice in treating this patient. He already has compromised cardiac function with such a poor pump and low EF. You don't want to give a calcium channel blocker and decrease his contractility any further. Try to figure out why the heart rate is high and address the cause- the tachycardia is a symptom of a bigger problem.
You could have tried Primacor (it helps the heart regulate calcium and causes a stronger contractility or pump), it will cause hypotension also (because it reduces your afterload, but this decreases the workload on the heart) so you'll definitely need your pressors. Dobutrex would also have been a good drug, in addition if you were really going to go all out treating, a balloon pump could have helped this patient.
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