REF: Braunwald12th ed.
| VASODILATORS: | INITIAL DOSE | EFFECTIVE DOSE RANGE |
|---|---|---|
| 1.Nitroglycerin | 20 μg/min | 40 - 400 μg/min |
| 2.Nitroprusside | 0.3 μg /kg/min | 0.3 - 5 μg /kg/min |
| 3.Nesiritide | 2 μg /kg bolus | 0.010 - 0.030 μg /kg/min |
| IONOTROPES: | ||
| 1.Dopamine | 4 - 5 μg /kg/min | 5 - 20 μg /kg/min |
| 2.Dobutamine | 1 - 2 μg /kg/min | 2 - 20 μg /kg/min |
| 3.Norepinephrine | 0.2 - 1 μg /kg/min | |
| 4.Epinephrine | 0.05 - 0.5 μg /kg/min | |
| 5.Milrinone | 25-75 μg /kg bolus over 10 – 20 mins, f/b infusion |
0.10 - 0.75 μg /kg/min |
| 6.Levosimendan | 12-24 μg /kg bolus over 10 min, f/b infusion |
0.5 - 2 μg /kg/min |
| 7.Digoxin | 0.5 mg IV | 0.25 mg IV or Oral 12 hours after initial dose and continue if needed |
| DIURETICS: | ||
| SEVERITY OF VOLUME OVERLOAD | DIURETIC | DOSE (mg) |
| 1.Moderate | Furosemide | 20-40 mg IV or up to 2.5 times oral dose (outpatient dose) IV |
| Bumetanide | 0.5 - 1 mg | |
| Torsemide | 10 - 20 mg | |
| 2.severe | Furosemide | 40-160 mg or up to 2.5 times Oral dose 5-40 mg/hr infusion |
| Bumetanide | 0.5-2 mg/hr (Max 2-4 mg/hr) | |
| Torsemide | 5-20 mg/hr | |
| Ultrafiltration | 200-500 mL/hr | |
| 3.Refractory to Loop diuretics | Add HCTZ | 25-50 mg twice daily |
| Metolazone | 2.5-10mg once daily | |
| Chlorothiazide | 250-500 mg IV 500-1000 mg PO |
|
| Spironolactone | 25-50 mg once daily | |
| 4.If alkalosis present | Acetazolamide | 0.5 mg IV |
| 5.Refractory to Loop & Thiazides | Add Dopamine (1-4 μg/kg/min - renal vasodilation) Dobutamine or Milrinone |
|
| Ultrafiltration or Hemodialysis (if associated renal failure present) |
