Norepinephrine

Question 1

Indications - norepinephrine

Answer 1

❑ Hypotension (< 70mmHg) refractory to other adrenergic agonists (sympathomimetics)
❑ Septic, Cardiogenic and Neurogenic shock
❑ Treatment of shock after fluid resuscitation
❑ Beta & Calcium Channel Blocker OD, Cholinesterase inhibitor poisoning, Cyclic Antidepressant OD, Digoxin OD, Ethanol
poisoning, Head injury with MAP <80mmHg, Non-cyclic Antidepressant OD, Salicylate OD, Sedative OD
❑ Vasopressor infusions may be administered after ROSC to support cardiac output, especially blood flow to the heart and brain

Question 2

Dosage - norepinephrine

Answer 2

Adult/Pediatric 0.1 – 1.0 mcg/kg/min. IV infusion (*start at low dose and titrate to desired blood pressure);

Mix 4 mg in 250 mL D5W or NS (16 mcg/mL)

Question 3

Contraindications - norepinephrine

Answer 3

❑ Mesenteric or peripheral vascular thrombosis
❑ Hypotension related to hypovolemia (except in an emergency to maintain coronary/cerebral perfusion until volume is replaced