Is 0.1 mcg/kg/min of Norepinephrine a High Dose?
No, 0.1 mcg/kg/min of norepinephrine is not a high dose—it represents the lower end of the standard dosing range for pediatric patients with distributive or hypotensive shock. 1
Standard Norepinephrine Dosing Range
The American Academy of Pediatrics recommends norepinephrine at 0.1–2.0 mcg/kg/min for hypotensive (usually distributive) shock with low systemic vascular resistance (SVR) that is unresponsive to fluid resuscitation. 1
The dosing should be titrated to achieve the desired clinical effect, starting at the lowest dose (0.1 mcg/kg/min) and increasing as needed. 1
Doses as high as 2.0 mcg/kg/min fall within the standard therapeutic range, meaning 0.1 mcg/kg/min is actually the starting dose, not a high dose. 1
Clinical Context for Norepinephrine Use
Norepinephrine is indicated for hypotensive septic shock or neurogenic shock where low SVR persists despite adequate volume resuscitation. 1
The medication should be administered via IV or intraosseous (IO) route with continuous hemodynamic monitoring. 1
Important Safety Considerations
Extravascular administration can result in severe skin injury. 1
If extravasation occurs, phentolamine (0.1–0.2 mg/kg up to 10 mg diluted in 10 mL of 0.9% sodium chloride) should be injected intradermally at the extravasation site to counteract dermal vasoconstriction. 1
Norepinephrine may cause tachycardia, bradycardia, arrhythmias, and hypertension, requiring close cardiovascular monitoring. 1
Dosing Algorithm
Confirm adequate fluid resuscitation before initiating norepinephrine for distributive shock. 1
Start at 0.1 mcg/kg/min and assess hemodynamic response (blood pressure, perfusion, urine output). 1
Titrate upward incrementally based on clinical response, up to 2.0 mcg/kg/min as needed. 1
Monitor continuously for adverse effects including arrhythmias and signs of peripheral ischemia. 1
Ensure secure IV/IO access to prevent extravasation injury. 1