What are the effects of epinephrine (Epi) drip on urine output?

From the Guidelines

Epinephrine drip can have variable effects on urine output, but vasopressin may have a greater impact on glomerular filtration pressure, leading to increased urine output compared to norepinephrine, as seen in studies such as 1. When considering the effects of epinephrine on urine output, it's essential to understand the underlying physiological mechanisms. Epinephrine causes vasoconstriction through alpha-1 adrenergic receptor stimulation, which can reduce blood flow to the kidneys and subsequently decrease glomerular filtration rate and urine production. However, the impact of epinephrine on urine output can vary depending on the dose and individual patient factors. Some key points to consider when evaluating the effects of epinephrine on urine output include:

• The dose of epinephrine, as higher doses tend to have more pronounced effects on renal blood flow and urine output
• The patient's underlying cardiac output and volume status, as these factors can influence the kidneys' ability to filter waste and produce urine
• The potential benefits of alternative vasopressors, such as vasopressin, which may have less renal vasoconstriction and improved effects on glomerular filtration pressure, as noted in studies like 1 In clinical practice, monitoring urine output closely in patients receiving epinephrine infusions is crucial, and adjusting the dose or adding alternative vasopressors may be necessary to maintain adequate renal perfusion and urine output, as suggested by research such as 1. It's also important to consider the individual patient's response to epinephrine and adjust treatment accordingly, taking into account factors such as cardiac output, volume status, and overall clinical condition, as discussed in studies like 1 and 1.

From the FDA Drug Label

5.5 Renal Impairment Epinephrine constricts renal blood vessels, which may result in oliguria or renal impairment. Epinephrine infusion significantly increased the MAP (69 vs. 86 mmHg) and cardiac output (6.4 vs. 7. 1 L/min) and decreased renal blood flow (330 vs. 247 mL/min).

The effects of an epinephrine drip on urine output are likely to be decreased, as epinephrine constricts renal blood vessels, which may result in oliguria or renal impairment 2. This is supported by animal studies, which showed that epinephrine infusion decreased renal blood flow 2. Key points to consider:

• Renal impairment: Epinephrine may cause renal impairment due to vasoconstriction.
• Oliguria: Decreased urine output is a potential effect of epinephrine administration.
• Decreased renal blood flow: Animal studies have demonstrated a decrease in renal blood flow with epinephrine infusion.

From the Research

Epi Drip Effects on Urine Output

• The effects of epinephrine (Epi) on urine output are not directly addressed in the provided studies, but the effects of other vasopressors such as norepinephrine (NE) and vasopressin are discussed 3, 4, 5, 6, 7.
• A study on the effects of norepinephrine on renal perfusion, filtration, and oxygenation in vasodilatory shock and acute kidney injury found that restoration of mean arterial pressure from 60 to 75 mmHg improves renal oxygen delivery, glomerular filtration rate (GFR), and urine flow 3.
• Another study compared the effects of vasopressin and epinephrine on splanchnic blood flow and renal function during and after cardiopulmonary resuscitation in pigs, and found that median urine output after return of spontaneous circulation showed no difference between the two groups 5.
• A study on the beneficial effects of vasopressin compared with norepinephrine on renal perfusion, oxygenation, and function in experimental septic acute kidney injury found that vasopressin induced a more sustained improvement in renal function than norepinephrine, without exacerbating renal medullary ischemia and hypoxia 6.
• A review of vasopressors and the kidney suggests that a beneficial effect of norepinephrine on urine output in sepsis is a consistent finding, but the effect on renal function (glomerular filtration) is less consistent 7.

Key Findings

• Restoration of mean arterial pressure from 60 to 75 mmHg improves renal oxygen delivery, GFR, and urine flow 3.
• Vasopressin induces a more sustained improvement in renal function than norepinephrine in experimental septic acute kidney injury 6.
• Norepinephrine has a beneficial effect on urine output in sepsis, but the effect on renal function is less consistent 7.

Limitations

• The provided studies do not directly address the effects of epinephrine (Epi) on urine output.
• The studies have different populations, designs, and outcomes, which may limit the generalizability of the findings.