Renal dose Dopamine question.

neneRN, BSN, RN · Apr 20, 2003

2.5 mcg/kg/min

pickledpepperRN · Apr 20, 2003

Three to five mcg/Kg/minute.

The problem is when the patient becomes hypotensive and the physician wants it titrated up to a minimum SBP of MAP. With 5 or 6 patients Q 5 to 15 minute BPs are not possible. This is a telemetry floor. I usually get the doctor to send that patient to ICU to R/O MI, cardiogenic shock, or other critical care need. They can crash quickly.

plumrn, BSN, RN · Apr 20, 2003

Our policy states only renal dose dopamine on the floor. No titrating, or they have to go to the unit for closer monitoring. Thank goodness, or I'm afraid patients would certainly be in jeopardy with the nurse to pt ratios the way they are on the floor.

Chttynurs · Apr 20, 2003

Where I work it's 2-4 mcg/kg/min, the highest our floor is allowed to go for BP support (which is the main reason we use dopa, not really for renal support) is 5 mcg/kg/min. But over the last year or so I've heard that there may be no such thing as renal dose dopa, and that the dopa simply raises the BP, which perfuses the kidneys better so they make urine. Anyone else hear this? :)

CCURN · Apr 20, 2003

Once I had a patient that came back from the cath lab with Dopa at 20mcg, Epi and Neo gtt and a IABP, overkill I think. Didnt really help though.....

We usually use 2.5mcg as a renal dose....

P_RN, ADN, RN · Apr 20, 2003

Based on weight but not over 5 mic/ and no titrating.

rstewart · Apr 20, 2003

Originally posted by Chttynurs
Where I work it's 2-4 mcg/kg/min, the highest our floor is allowed to go for BP support (which is the main reason we use dopa, not really for renal support) is 5 mcg/kg/min. But over the last year or so I've heard that there may be no such thing as renal dose dopa, and that the dopa simply raises the BP, which perfuses the kidneys better so they make urine. Anyone else hear this? :)

The issue is: Do so-called renal doses of dopamine actually have a renal protective effect and/or improve outcomes? The evidence is that it does not appear to do either. Keep in mind that achieving adequate urine output is not equivalent to achieving adequate renal function.

I find it amusing what we have come to accept as safe on hospital floors. And an arbitrary dose cap such as 2-4/mcg/kg/min is but one example. The nurse in 2003 would surely be ridiculed as overreacting if he/she expressed concern about caring for such a patient with several others. But where is the research support for this practice? In my experience I have seen many patients (particularly renal patients) who have a strong sensitivity to dopamine; that is, at so-called renal doses of dopamine they appear to have adequate blood pressure and perfussion but without the seemingly low dose, they are unable to sustain one or the other.

I think people would be surprised to see how many patients return to the ICU because they have not been carefully monitored enough while receiving some powerful medications. Another current example is some of the drugs used to address heart failure. They are often given on the floor but they have a vasodilatory effect which can result in pretty extreme hypotension.

ageless · Apr 20, 2003

...3 mcg is our standerd

ptnurse · Apr 20, 2003

My ACLS book specifically states that there is no such thing as a renal dose of dopamine.

altomga, ADN, BSN, MSN, DNP, RN, APRN · Apr 20, 2003

Our renal dose is 2-4mcg/kg/min. Our max for BP is 10mcg. Our docs go on the bases that this dose increases renal perfusion.

I do work on a step-down ICU floor though, so our patients are monitored closely and we insist on central lines for dopamine!! It may start peripherally, but not end there. Too risky of infiltration and necrosis occuring!!! Especially if a new nurse is not aware of the severe complications that infiltration of dopamine can do and/or the antidote!

susanmary · Apr 21, 2003

I find it amusing what we have come to accept as safe on hospital floors. And an arbitrary dose cap such as 2-4/mcg/kg/min is but one example. The nurse in 2003 would surely be ridiculed as overreacting if he/she expressed concern about caring for such a patient with several others. But where is the research support for this practice? ... I think people would be surprised to see how many patients return to the ICU because they have not been carefully monitored enough while receiving some powerful medications. [/b]

This is the best post I have read on this bulletin board -- and rings very true.