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Calculate infusion rates and convert between vasopressor dosing units
Typical range: 0.05-0.3 mcg/kg/min
Standard: 16 mcg/mL (4 mg in 250 mL)
Rate (mL/hr) = (Dose × Weight × 60) / Concentration
| Medication | Typical Dose | Receptor Activity | Primary Use |
|---|---|---|---|
| Norepinephrine | 0.05-0.3 mcg/kg/min | α₁ >> β₁ | First-line for septic shock |
| Epinephrine | 0.05-0.5 mcg/kg/min | α₁, β₁, β₂ | Anaphylaxis, cardiac arrest |
| Vasopressin | 0.03-0.04 units/min | V₁ receptor | Adjunct to norepinephrine |
| Dopamine | 5-20 mcg/kg/min | D₁, β₁, α₁ (dose-dependent) | Bradycardia with hypotension |
| Phenylephrine | 0.5-3.0 mcg/kg/min | α₁ (pure) | Hypotension with tachycardia |
| Dobutamine* | 2.5-20 mcg/kg/min | β₁ >> β₂, α₁ | Cardiogenic shock (inotrope) |
*Dobutamine is an inotrope, not a vasopressor
First-line: Norepinephrine. Second-line: Add vasopressin (0.03 units/min). Consider epinephrine if refractory.
Dobutamine (inotrope) for contractility. Add norepinephrine if persistent hypotension. Consider epinephrine.
Phenylephrine or norepinephrine. Avoid pure beta-agonists. May cause bradycardia initially.
Epinephrine first-line (IM then IV). Add norepinephrine if refractory. Volume resuscitation essential.
Always optimize volume status before starting or escalating vasopressors. Vasopressors in hypovolemic patients can worsen tissue perfusion.
Vasopressors should be given via central line when possible. Peripheral extravasation can cause tissue necrosis. Use large peripheral IV temporarily if needed.
Target MAP ≥65 mmHg for most patients. May need higher targets (75-85) in chronic hypertension. Assess end-organ perfusion, not just blood pressure.
As patient improves, wean vasopressors slowly. Remove adjunct agents first, then reduce primary vasopressor. Monitor for hypotension.
Multiple studies show norepinephrine has lower risk of arrhythmias compared to dopamine, particularly in septic shock. Norepinephrine is now the first-line vasopressor for most shock states.
Add vasopressin (0.03-0.04 units/min) when norepinephrine requirements are increasing or doses exceed 0.25-0.5 mcg/kg/min. Vasopressin is a fixed-dose adjunct, not titrated. It may allow reduction in catecholamine doses.
Temporarily yes, through large peripheral IV, but central access is strongly preferred. Extravasation can cause severe tissue injury and necrosis. If peripheral, use most proximal IV possible and transition to central line urgently.
Vasopressors increase blood pressure primarily through vasoconstriction (alpha effects). Inotropes increase cardiac contractility (beta-1 effects). Some agents like epinephrine have both properties. Dobutamine is pure inotrope.
There is no direct equivalence between different vasopressors due to different mechanisms and receptor profiles. When switching agents, start the new vasopressor, titrate to effect, then wean the first agent. Do not abruptly stop vasopressors.
Complications include arrhythmias, tissue ischemia (digital, limb, bowel), myocardial ischemia, hyperglycemia, and lactic acidosis. High doses significantly increase these risks. Monitor extremities, lactate, and end-organ function closely.
Vasopressor therapy requires intensive monitoring in critical care settings. This calculator is for educational purposes only. All vasopressor dosing must be determined and supervised by qualified healthcare providers. Requires continuous blood pressure monitoring, central venous access (preferred), and assessment of end-organ perfusion. Not for use outside of intensive care environments.