Dopamine Infusion Preparation and Administration
Prepare dopamine by adding 400 mg to 500 mL of 5% dextrose in water (D5W) to create an 800 mcg/mL concentration, which is the standard preparation for most patients. 1
Standard Preparation Methods
Adult Concentration Options
- Standard concentration (800 mcg/mL): Add 400 mg dopamine to 500 mL D5W—this is preferred when fluid expansion is not problematic 1
- Concentrated solution (1600 mcg/mL): For fluid-restricted patients or when slower infusion rates are desired 1
- Highly concentrated solution (3200 mcg/mL): Reserved for severe fluid restriction scenarios 1
Pediatric Preparation Using "Rule of 6"
- Multiply 6 × body weight (kg) = number of milligrams to add to 100 mL of saline 2, 3
- Then 1 mL/hour delivers 1 mcg/kg/min 2
- Example: For a 10 kg child, add 60 mg dopamine to 100 mL saline 2
Critical Preparation Requirements
Solution Compatibility
- Use only D5W or normal saline—dopamine is stable in these solutions at pH ≤6.85 for at least 48 hours at room temperature 4
- Never mix with sodium bicarbonate or alkaline solutions—dopamine is inactivated in alkaline environments and will turn pink, indicating degradation 1, 4
- Do not administer if solution is darker than slightly yellow or discolored in any way 1
Equipment and Administration Route
- Use only an infusion pump, preferably volumetric—gravity drip with mechanical clamps is inadequate for safe dopamine administration 1
- Infuse into a large vein (antecubital fossa preferred) to prevent extravasation and tissue necrosis 1
- Avoid dorsal hand or ankle veins unless no other access is available and immediate treatment is required 1
- Do not use umbilical artery catheters for dopamine administration 1
Dosing Guidelines
Initial Dosing Strategy
- Start at 2-5 mcg/kg/min for patients likely to respond to modest increases in cardiac output and renal perfusion 1, 3
- Start at 5 mcg/kg/min for more seriously ill patients, then increase in 5-10 mcg/kg/min increments up to 20-50 mcg/kg/min as needed 1
- Titrate to maintain systolic BP >90 mmHg in adults (or age-appropriate targets in children) 2, 3
Dose-Dependent Pharmacologic Effects
- 2-5 mcg/kg/min: Dopaminergic receptor stimulation causing renal and mesenteric vasodilation 3
- 5-10 mcg/kg/min: Beta-adrenergic effects increasing cardiac contractility and output 3
- >10 mcg/kg/min: Alpha-adrenergic effects causing peripheral vasoconstriction 3
Maximum Dosing
- Doses >50 mcg/kg/min have been used safely in advanced circulatory decompensation, but require frequent urine output monitoring 1
- More than 50% of adults are maintained on <20 mcg/kg/min 1
Monitoring Requirements
Continuous Monitoring Parameters
- Blood pressure (preferably via arterial line at higher doses) 3
- Heart rate and ECG continuously 3
- Urine output frequently, especially at doses >50 mcg/kg/min 1
- Peripheral perfusion and capillary refill 3
- Arterial lactate and central venous oxygen saturation to assess tissue oxygen delivery 3
Signs Requiring Dose Reduction
- Diminishing urine output in absence of hypotension 1
- Increasing tachycardia or new dysrhythmias 1
- Disproportionate rise in diastolic pressure (marked decrease in pulse pressure) indicating excessive vasoconstriction 1
Critical Safety Precautions
Extravasation Management
- Monitor infusion site continuously for free flow 1
- If extravasation occurs: Inject phentolamine 5-10 mg diluted in 10-15 mL saline intradermally at the site immediately 3
- Pediatric phentolamine dose: 0.1-0.2 mg/kg up to 10 mg 3
Drug Incompatibilities
- Never add sodium bicarbonate or other alkalinizing substances—dopamine is inactivated in alkaline solution 1
- Do not infuse simultaneously with blood through the same line when using dextrose solutions (risk of pseudoagglutination) 1
Volume Considerations
- Be aware of IV bag overfill: 100 mL bags may actually contain 107-114 mL, causing clinically significant overdilution of dopamine 5
- Use in-line burets or premixed bags when precise dosing is critical to prevent unintended adverse drug events 5
Discontinuation Protocol
- Gradually decrease the dose while expanding blood volume with IV fluids to prevent marked hypotension 1
- Do not abruptly stop the infusion 1
Special Clinical Considerations
When Dopamine May Be Less Effective
- In patients on beta-blockers: Consider alternative vasopressors, as dopamine may be less effective and beta-blocker-related anaphylaxis may be refractory to management 2
- In marked circulatory instability: Epinephrine or norepinephrine may be preferable to dopamine in infants with decompensated shock 3