Vasopressors and inotropes
Vasopressin (Vasostrict) drip
Vasostrict, Pitressin
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Dosing
| Start | 0.03 units/min, usually fixed (some start at 0.01) |
|---|---|
| Titrate | Usually not titrated; label allows 0.005 units/min steps every 10–15 minutes |
| Maximum | 0.04 units/min in common practice; label up to 0.07 in septic shock |
| Common bags | 20 units in 100 mL (0.2 units/mL); 40 units in 100 mL (0.4 units/mL) |
| Dose units | units/min |
Line and administration
- Central line preferred
Watch for
- Digital, skin and gut ischemia
- Low sodium
- Lower cardiac output and heart rate
Vasopressin: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Vasopressors and InotropesReceptors and effects: Vasopressin: V1 (V2 in kidney): ↔ or ↓ / ↔ / ↑↑
- Sepsis and Septic Shock BundleVasopressors and MAP: 2nd: Vasopressin: Fixed 0.03 units/min, added as NE rises; not titrated
- After Cardiac SurgeryTamponade, low output or vasoplegia?: Vasoplegia: MAP under 65, CI over 2.2, SVR under 800 (risks: long bypass, preop ACE inhibitors). Norepinephrine plus vasopressin; if refractory, methylene blue 1 to 2 mg/kg (serotonin syndrome with SSRIs, falsely low SpO2, G6PD hemolysis) or hydroxocobalamin 5 g (red urine, lab interference, CRRT blood-leak alarms). Follow your institution's protocols.
- Endocrine EmergenciesAdrenal physiology, adrenal crisis and stress-dose steroids: CRH and vasopressin drive pituitary ACTH, which drives cortisol with a morning peak; aldosterone answers mainly to angiotensin II and potassium. Cortisol is permissive for vascular tone (it sustains α₁ and angiotensin responsiveness and restrains NO), raises glucose and lets the kidney excrete free water; resting output is about 9–10 mg/
- Right Heart Failure and Pulmonary HypertensionManagement priorities: Pressure: norepinephrine, then vasopressin; MAP 65 or more (WSPH 2024: 70–75), aortic above PA pressure.
- End of Life, Brain Death and Organ DonationOrgan donation: DI is common: desmopressin or vasopressin
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.