Dopamine

Class

  • naturally occurring catecholamine

Mechanism of Action

  • dopamine and adrenoreceptor agonist
    • 1-5mcg/kg/min – D 1 & 2 receptors (inotropy
    • 5-10mcg/kg/min – direct & indirect effects on beta receptors -> inotropy
    • >10mcg/kg/min – alpha effects -> vasoconstriction
  • immediate precursor to noradrenaline
  • neurotransmitter in the nervous system
  • increases aldosterone secretion

Dose

  • 1-20mcg/kg/min (onset: 5min, duration: 10min)

Pharmaceutics

  • ampoule 200mg/5mL + meta-bisulfite

Indications

  • low Q states

Adverse Effects

  • arrhythmias
  • pulmonary artery vasoconstriction
  • caution with MAO-I and phenytoin
  • N+V
  • immune dysfunction
  • decreased GI oxygenation in shock states
  • diuresis in patients who are hypovolaemia
  • inhibits TSH and prolactin release

PK

  • Absorption – IV
  • Distribution
  • Metabolism – hepatic and adrenergic nerve endings (MAO and COMT)
  • Elimination – urinary, T1/2 = 2min

Evidence

Myles, P.S et al (1993) “’Renal dose’ dopamine on renal function following cardiac surgery” Anaes. Intens. Care 21:56

  • CABG patients
  • dopamine 200mcg/min vs placebo for 24 hours
  • -> no improvement in CrCl

Duke G.J. et al (1994) “Renal support in critically ill patients: low-dose dopamine vs low dose dobutamine?” Critical Care Medicine, 22:(12), page 1919-25

  • RCT
  • placebo vs dopamine vs dobutamine
  • -> increased U/O with dopamine but no change in CrCl
  • -> improved CrCl while no change in U/O with dobutamine compared with placebo
  • -> increased urine output is not synonymous with improved renal function

ANZICS (2000, Lancet)

  • RCT – dopamine vs placebo
  • no change in Cr, ICU LOS, hospital LOS, RRT
  • -> don’t use low dose dopamine for renal protection

De Backer, D. et al (2010) “Comparison of dopamine and norepinephrine in the treatment of shock” N Engl J Med, 362:779-789

  • MRCT
  • n = 858
  • 50% of patients died in both groups
  • -> no difference in mortality rates (ICU, 6 months and 12 months)
  • -> more arrhythmias
  • -> increased risk of death @ 28 days with dopamine + cardiogenic shock

Patel, G.P. et al (2010) “Efficacy and safety of dopamine versus norepinephrine in management of septic shock” Shock 33:375-380

  • SRCT
  • n = 252 with septic shock in a medical ICU
  • -> more arrhythmias in dopamine group
  • -> no difference in 28 day mortality

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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