Renal dose Dopamine question.

Nurses General Nursing

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What is considered a renal dose for Dopamine on your floor?

On our surgical unit, our standard is 5mcg/kg/min. I have heard this is just a little higher than some others. How about where you work?

Specializes in NICU.

2mcg/kg/min in NICU

renal use is not usual in this care unit. But when it's necesary whe diluyed 1 g of dopamine in 500 ml Dx5% between 3 and 6 ml/h

In many australian hosptial renal dose of dopamine is 3mcg/kg/min. Titration is absolutly no no on genral ward. Renal dose of dopamine is Only used to increase uinary output on the floor. It is not for cardiac managment, such as hypotension.

Specializes in Emergency Nursing Advanced Practice.

For a decade or more many people have urged caution with dopamine. The most

recent such editorial was entitled 'Renal dose dopamine: long on conjecture,

short on fact' by H.L. Corwin and A. Lisbon, Crit Care Med, 2000,

28:1657-1658. The popularity of dopamine stems from uncontrolled studies in

the 70s and 80s demonstrating natriuresis and diuresis, leading to the

conjecture that this might be nephroprotective. No prospective randomised

study has demonstrated this. The most recent paper I have seen is Ichai C.

et al, CCM, 2000, 28:1329-1335, to which the above editorial related. This

group looked at a total of EIGHT patients in a crossover fashion, and only

demonstrated a transient diuresis and increase in creatinine clearance and

FeNa, maximal at eight hours but the effect was lost by 48 hours. I

surprised that a negative paper describing only eight patients ever got

published, but this is the quality of the dopamine literature.

The Australian and New Zealand Intensive Care Society (ANZICS) Clinical

Trials Group has looked at dopamine in a large multicentre double blinded

placebo controlled prospective trial of over 700 patients. No difference was

found between dopamine and saline at two interim analyses, looking at

creatinine (peak or increase), incidence of renal failure, days of

ventilation, ICU or hospital length of stay, and ICU or hospital mortality.

The final study has been adequately powered to make a false negative

unlikely, and will be published this year in the Lancet.

Have a look also at Kellum JA and Bellomo R, Low dose dopamine: what

benefit?, CCM, 2000, 28:907-908. Bellomo was one the principle investigators

in the ANZICS trial.

In the absence of any good evidence supporting the use of dopamine, and the

well known neurohumoral and splanchnic adverse effects, it is hard to

justify the continuing use of dopamine in the ICU,

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