sician also should observe the patient for signs of reversal of mental confusion or coma. loss of pallor, increase in toe temperature or adequacy of nail bed capillary filling also may be observed as indices of adequate dosage. reported studies indicate that when dopamine is administered before urine flow has decreased to approximately 0.3 ml/minute prognosis is more favorable. however, it has been observed that in some oliguric or anuric patients, administration of the drug has produced an increase in urine flow which may reach normal levels. the drug also may increase urine flow in patients whose output is within normal limits and thus may help in reducing the degree of pre-existing fluid accumulation. conversely, at higher than optimal doses for a given patient, urinary flow may decrease, requiring a reduction of dosage. concomitant administration of dopamine and diuretic agents may produce an additive or potentiating effect. low cardiac output: dopamine's direct inotropic effect on the myocardium which increases cardiac output at low or moderate doses is related to a favorable prognosis. increased output has been associated with unchanged or decreased systemic vascular resistance (svr). the association of static or decreased svr with low or moderate increases in cardiac output is regarded as a reflection of differential effects on specific vascular beds, with increased resistance in peripheral beds (e.g., femoral), and concurrent decreases in mesenteric and renal vascular beds. redistribution of blood flow parallels these changes so that an increase in cardiac output is accompanied by an increase in mesenteric and renal blood flow. in many instances the renal fraction of the total cardiac output has been found to increase. increase in cardiac output produced by dopamine is not associated with substantial decreases in systemic vascular resistance as may occur with isoproterenol. hypotension: low to moderate doses of dopamine, which have little effect on svr, can be used to manage hypotension due to inadequate cardiac output. at high therapeutic doses, dopamine's α-adrenergic action becomes more prominent and thus may correct hypotension due to diminished svr. as in other circulatory decompensation states, prognosis is better in patients whose blood pressure and urine flow have not undergone extreme deterioration. therefore, it is suggested the physician administer dopamine as soon as a definite trend toward decreased systolic and diastolic pressure becomes apparent.

immediate attention. the physician should switch to a more suitable site as soon as possible and the infusion site in use should be continuously monitored for free flow. the less concentrated 800 mcg/ml solution may be preferred when fluid expansion is not a problem. the more concentrated 1600 mcg/ml or 3200 mcg/ml solutions, may be preferred in patients with fluid retention or when a slower rate of infusion is desired. rate of administration: administration into an umbilical artery catheter is not recommended. dopamine in 5% dextrose injection should not be infused through ordinary intravenous apparatus, regulated only by gravity and mechanical clamps. only an infusion pump, preferably a volumetric pump, should be used. each patient must be individually titrated to the desired hemodynamic or renal response to dopamine. in titrating to the desired increase in systolic blood pressure, the optimum dosage rate for renal response may be exceeded, thus necessitating a reduction in rate after the hemodynamic condition is stabilized. if a disproportionate rise in diastolic pressure (i.e., a marked decrease in pulse pressure) is observed in patients receiving dopamine, the infusion rate should be decreased and the patient observed carefully for further evidence of predominant vasoconstrictor activity, unless such an effect is desired. administration rates greater than 50 mcg/kg/min have safely been used in adults in advanced circulatory decompensation states. if unnecessary fluid expansion is of concern, adjustment of drug concentration may be preferred over increasing the flow rate of a less concentrated dilution. when discontinuing the infusion, it may be necessary to gradually decrease the dose of dopamine hcl while expanding the blood volume with intravenous fluids to prevent the development of marked hypotension. suggested regimen: 1. when appropriate, increase blood volume with whole blood or plasma until central venous pressure is 10 to 15 cm h2o or pulmonary wedge pressure is 14 to 18 mm hg. 2. begin infusion of dopamine hydrochloride solution at doses of 2 to 5 mcg/kg/min in adult or pediatric patients who are likely to respond to modest increments of heart force and renal perfusion. in more seriously ill patients, begin infusion of dopamine hydrochloride at doses of 5 mcg/kg/min and increase gradually, using 5 to 10 mcg/kg/min increments, up to a rate of 20 to 50 mcg/kg/min as needed. if doses in excess of 50 mcg/kg/min are required, check urine output frequently. should urinary flow begin to decrease in the absence of hypotension, reduction of dopamine dosage should be considered. more than 50% of adult patients have been satisfactorily maintained on doses less than 20 mcg/kg/min. in patients who do not respond to these doses with adequate arterial pressures or urine flow, additional increments of dopamine may be given in an effort to produce an appropriate arterial pressure and central perfusion. 3. treatment of all patients requires constant evaluation of therapy in terms of blood volume, augmentation of cardiac contractility, urine flow, cardiac output, blood pressure, and distribution of peripheral perfusion. dosage of dopamine should be adjusted according to the patient's response. diminution of established urine flow rate, increasing tachycardia or development of new dysrhythmias are reasons to consider decreasing or temporarily suspending the dosage. 4. as with all potent intravenously administered drugs, care should be taken to control the rate of infusion so as to avoid inadvertent administration of a bolus of the drug. 800 mcg/ml dosing chart for dopamine (ml/hr) infusion rate 1600 mcg/ml dosing chart for dopamine (ml/hr) infusion rate 3200 mcg/ml dosing chart for dopamine (ml/hr) infusion rate parenteral drug products should be visually inspected for particulate matter and discoloration prior to administration, whenever solution and container permit. dosage 1 dosage 2 dosage 3

ries. carbohydrate in the form of dextrose may aid in minimizing liver glycogen depletion and exerts a protein-sparing action. dextrose injected parenterally undergoes oxidation to carbon dioxide and water. water is an essential constituent of all body tissues and accounts for approximately 70% of total body weight. average normal adult daily requirement ranges from two to three liters (1.0 to 1.5 liters each for insensible water loss due to perspiration and urine production). water balance is maintained by various regulatory mechanisms. water distribution depends primarily on the concentration of electrolytes and sodium (na+) plays a major role in maintaining physiologic equilibrium. the reported clearance rate of dopamine in critically ill infants and children has ranged from 46 to 168 ml/kg/min, with the higher values seen in the younger patients. the apparent volume of distribution in neonates is reported as 0.6 to 4 l/kg, leading to an elimination half-life of 5 to 11 minutes.