Vasopressin & Shock

 

Case

We recently administered vasopressin post bypass in a patient with vasodilatory shock (high cardiac index and low SVRI) with very good effect. The large noradrenaline requirements were able to be quickly reduced. I know most of you are aware of this treatment and there was a good review of vasopressin in Anaesthesia and Intensive Care last year. I thought I would just review the doses used as there is little information about this.

Recommendations

Vasopressin comes as a 20IU/mL ampoule and, according to the review article, a bolus dose of up to 10 IU can be given. I would recommend a starting bolus of 1-2 IU as significant hypertension may occur. The recommended infusion doses are 0.1-0.4 IU/min which is 6-24 IU/hr. If we used 2 ampoules (40 IU) in a 50 mL infusion this corresponds to an infusion regime of 7-28 mL/hr. Provided the drug is used in vasodilatory shock (ie good index) side effects seem to be limited.

Submitted by Dr Chris Cokis, email: ccokis@cyllene.uwa.edu.au

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