Does Dobutamine fall into a category of Diuretics somehow?

[chitchat]

I work in rural(?) hospital tele unit. I was talking to a couple of my co-workers about cardiac medication dose titrating upon dry weight a few weeks ago. They didn't seem to know what dry weigh is and some of people there titrating the drug dose every day per daily weight. This is not the only frustrating part.

Some of them told me that Dobutamine is diuretics(according to that nurse, patient who has dobutamin drip puts out alot of urine output?? I understand that CHF patients have dobutamine drip also has a bunch of diuretics as well and dobutamine itself increases blood flow to kidneys.

I have friends who work in ICU. They never heard of it and I never heard of it either. But I am not a scholar and I didn't read all the literature in nursing and medicine. Does anybody know if Dobutamine falls into a category of diuretics somehow?

[grandmawrinkle]

Oh Lordy. I feel for you. It appears as though there is no one at your job that knows what they are doing.

Dobutamine is an inotrope. It's used typically for squeeze and to increase cardiac output, which could in turn, increase renal perfusion/urine output. I would not say that I have generally seen it used in cases of CHF where the patient's primary need is to be diuresed, however. Typically if someone's CHF is so advanced to need dobutamine (or other inotrope) management, they have a SG catheter placed to guide therapy. Many, many patients that come into the hospital for CHF just get IV diuresis these days and sent home with their cardiac meds (oral) optimized (newer therapies for long term low EFs/CHF include biventricular pacers as well, etc.) I'm not sure that using dobutamine in this way is an old concept or not -- but I am thinking that it is. If a patient has a chronic, low EF, I'm not sure that a day or two of a dobutamine gtt is going to improve their long term prognosis, but I'd have to do a lit review to say this definitively.

Are you thinking of dopamine? That is more commonly used, low dose, for renal perfusion/increase UO (also controversial and old therapy, and in my experience, only works about 5% of the time.)

Either one of those drugs (dopamine or dobutamine) are not considered diuretics, to answer your first question. I'm not sure why your ICU nurse friends don't know about dobutamine. It might not be used often in their practice, but it's an old-standby ICU drug. They should have at least been taught about it in their ICU classes/orientation period.

Using the admission ("dry") weight is the standard of care everywhere I've ever worked for weight-based drips. Where is your nurse manager on that issue? That should be reinforced to the staff.

[chitchat]

Thank you for a quick answer. There is a misunderstanding in my question. I meant my ICU friends said they never heard of Dobutamine being Diuretics. Neither did I.

Of course My friends and I knew Dobutamine. Our organization uses Dobutamine more often than Dopamine for CHF patients. I saw it in the literature. It said Dobutamine therapy is useful treatment of Pul. congestion and low cardiac output and in hypotensive patients with pul. congestion who cannot tolerate vasodilators.

[grandmawrinkle]

What part of the country are you in? My area has stopped using dobutamine, mostly. It's always interesting to see who does what where.

[FSU_NOLEGIRL_RN]

I have seen doctors use it in the ICU for patients who do not respond to regular methods to increase BP and renal perfusion lik efluid bolus and diuretics, as well as in code situations.

[fiveofpeep]

ala micromedix:

"Dobutamine has no direct dopaminergic effect on the renal vasculature. It enhances renal profusion by increasing cardiac output. One study demonstrated that during the preinfusion period, the serum BUN and creatinine in 25 patients rose an average of 3.9% per day and 0.84% per day, respectively (Leier et al, 1977). During the 72 hour infusion period the serum BUN dropped 9.1% per day and the creatinine fell 2.2% per day (both P less than 0.05). Both the urine flow and urine sodium concentration increased significantly during the infusion period compared to preinfusion values (Leier et al, 1977). Therefore, dobutamine will not divert blood flow from the kidneys, as can isoproterenol, restrict blood flow, as does norepinephrine, or have a specific renal vasodilating effect, as dopamine (Westman & Jarnberg, 1987; Leier et al, 1977; Beregovich et al, 1975; Holloway & Frederickson, 1974; Robie & Goldberg, 1975)."