Amiodarone
Indications: Wide-complex tachydysrhythmias
New-onset atrial fibrillation (conversion to sinus rhythm)
Stable monomorphic ventricular tachycardia
Polymorphic ventricular tachycardia with normal QT interval
Rate controller due to accessory pathway conduction
in pre-excited atrial arrhythmias
Preferred in: Acute myocardial infarction
Left ventricular dysfunction
• Stable patient: Amiodarone 150 mg SIVP over 10 mins
(may repeat same dose every 10 mins up to 2 gms)
• Amiodarone drip: Amiodarone 150 mg + 100 ml PNSS x 10 mins,
followed by 1 mg/min for 6 hrs, then 0.5 mg/min for the next 18 hrs
• Amiodarone 300 mg + 250 ml D5W / PNSS over 24 hours
Dopamine
ml/hr = mcg/kg/min x weight x 60 x ml (solution)
mg (stock) x 1000
1 vial = 200 mg/5 ml (40 mg/ml)
Dose range = 2 to 20 mcg/kg/min
5 to 10 mcg/kg/min
renal blood flow & cardiac output, positive inotropic & chronotropic
>10 mcg/kg/min
vasoconstriction and increase blood pressure
Dobutamine
ml/hr = mcg/kg/min x weight x 60 x ml (solution)
mg (stock) x 1000
1 vial = 250 mg/5 ml (50 mg/ml)
Dose range = 2 to 20 mcg/kg/min
Uses: Acute decompensated heart failure
Cardiogenic shock
Vasodilatory shock (septic shock)
Norepinephrine
ml/hr = mcg/kg/min x weight x 60 x ml (solution)
mg (stock) x 1000
1 vial = 4 mg/4 ml (1 mg/ml)
Dose range = 2 to 50 mcg/min
0.02 to 2 mcg/kg/min
Uses: Acute hypotension
Post-cardiac arrest patients
Severe sepsis and septic shock
(refractory to adequate fluid resuscitation)
Mannitol
Loading dose: 0.5 to 1.0 mg/kg x weight x 100
20
IV infusion: 1.5 to 2 g/kg over 30 to 60 mins
1 vial Mannitol = 20 mg/100 ml
Uses: Increased intracranial pressure
Increased intraocular pressure
Insulin Drip
Humulin R 100 units + 100 ml PNSS x 0.1 unit/kg/hr
Epinephrine Drip
Epinephrine 1 mg + 250 ml D5W x 15 to 150 ugtts/min
Dose = 2 – 10 mcg/min
Omeprazole Drip
Omeprazole 80 mg + 90 ml PNSS x 8 mg/hr x 10 hrs
Tramadol Drip
Tramadol 300 mg + 250 ml D5W x 24 hrs
Nalbuphine Drip
Nalbuphine 10 mg + 250 D5W x 24 hrs
Nicardipine
Nicardipine 10 mg + 90 ml PNSS x 10 ml/hr (1 mg/hr)
Titrate: 2.5 mg/hr every 5 to 15 mins
Maximum dose: 15 mg/hr
Isosorbide dinitrate (ISDN) Drip
Single concentration:
Isoket 10 mg + 90 ml PNSS x 10 ml/hr (1 mg/hr)
(10 to 50 ml/hr or 1 to 5 mg/hr)
Double concentration:
Isoket 20 mg + 80 ml PNSS x 5 ml/hr (1 mg/hr)
(5 to 25 ml/hr or 1 to 5 mg/hr)
Sodium Bicarbonate (NaHCO3)
HCO3 Deficit (mEqs) = 0.4 x kg x (24 – actual)
2
1) Give 1/2 of volume as IV bolus
2) Give 1/2 as drip: NaHCO3 (mEqs) + 250 ml PNSS x 24 hrs
Hypokalemia
K+ Deficit = (Expected K+ - Actual K+) x ICF
Intracellular fluid (ICF) = 0.4 x kg
Moderate Hypokalemia (K+ < 3.0):
40 mEqs KCl + 1000 ml PNSS x 8 hours
Severe Hypokalemia (K+ < 2.0):
10 – 20 mEqs KCl + 100 ml PNSS x 1 hr x 3 cycles
Repeat serum potassium after 3rd cycle
Hyponatremia
Expected ∆Na+ (mEq/L) = Infusate Na+ - Actual serum Na+
(TBW + 1)
Infusates: Total Body Water = kg x %
3% Hypertonic Saline = 513 mEq/L 60% adult male <65 & children
0.9% Normal Saline = 154 mEq/L 50% adult female <65 & elderly male
45% elderly female
How much to give? ml = 1000 ml x 5 mEqs x 6 hrs
Expected DNa+
Chronic hyponatremia: >48 hours of suspected hyponatremia
à 6 mEqs in 24 hours (high risk patients)
à 12 meqs in 24 hours (low risk patients)
Hypocalcemia
Calcium gluconate 1 amp + 10 – 30 ml IV x 10 – 20 mins
(May repeat every 60 mins)
Ca2+ gluconate infusion: 0.02 – 0.08 ml/kg/hr
Hypomagnesemia
MgSO4 1 to 4 grams + 100 ml D5W or PNSS x 10 – 60 mins
MgSO4 2 grams + 50 ml PNSS x 20 mins
Levetiracetam
Levetiracetam 500 mg or 1 gram + 100 ml PNSS x 15 mins
Furosemide
Furosemide 200 mg + 100 ml PNSS x 20 mg/hr
Midazolam
Midazolam 50 mg + PNSS to make 100 ml x 3 mg/hr
