Noradrenaline Infusion Guidelines

Preparation and Dosing

Noradrenaline is the first-line vasopressor for management of hypotension in septic shock, as recommended by the Society of Critical Care Medicine 1
The standard preparation of noradrenaline is 4 mg in 250 ml D5W, resulting in a 16 μg/ml concentration, according to the Mayo Clinic Proceedings 2

For a 70 kg adult, the starting dose of 0.02 μg/kg/min equals approximately 5 ml/hour, with a 16 μg/ml concentration 2, 1

The goal is to maintain a mean arterial pressure (MAP) ≥65 mmHg, with titration increments of 0.02-0.05 μg/kg/min every 5-10 minutes based on response, as recommended by the Society of Critical Care Medicine 1, 2

Peripheral administration of noradrenaline is acceptable initially while central access is being established, according to the Mayo Clinic Proceedings 2
Continuous arterial blood pressure monitoring is recommended when available, and concurrent fluid resuscitation is essential, typically 30 ml/kg crystalloid in septic shock 2
If there is an inadequate response to noradrenaline alone, consider adding vasopressin 0.04 units/min, as suggested by the Mayo Clinic Proceedings 2

If extravasation occurs, infiltrate the area with 10-15 ml saline containing 5-10 mg of phentolamine, as recommended by the American Academy of Pediatrics 3

Elderly patients may be more sensitive to noradrenaline effects and may require lower doses, according to the American Heart Association 4