General information

Dopamine is a naturally occurring catecholamine and central neurotransmitter capable of raising cardiac output, reducing peripheral resistance, and specifically increasing renal blood flow. Infusions (generally up to 10 micrograms/kg/hour) have proven valuable in shock and congestive heart failure.

Common adverse reactions during infusion include extra beats, tachycardia, and palpitation. Angina pectoris, bradycardia, altered cardiac conduction, nausea and vomiting, headache, and dyspnea can occur. Piloerection and uremia have been reported and blood pressure can either rise or fall.

In low doses the effects of dopamine are generally limited to dopamine receptors; at higher doses it also has beta-adrenoceptor agonist effects, and at higher doses still is an alpha-adrenoceptor agonist. A report from Bulgaria suggests that the last of these actions can nevertheless occur at relatively low doses [ ].

  • A 64-year-old man with diabetes mellitus developed septicemia and toxic shock secondary to gangrene in the right leg. Because of poor renal function he was given an infusion of dopamine, initially 1.25 micrograms/kg/minute, increasing to 2.5 micrograms/kg/minute because of a poor response. There was a good diuretic response, but after 36 hours all the fingers of both hands, except the thumbs, had become ischemic, as had the previously normal left leg. In fact the right leg was amputated, possibly because of dopamine-exacerbated ischemia but this was unclear. Dry gangrene also developed in the affected fingers, although it is also unclear whether they were saved.

Organs and systems

Cardiovascular

The major risk during dopamine treatment is that of severe peripheral ischemia, particularly in patients in whom the peripheral circulation is already impaired, since dopamine is converted to noradrenaline; gangrene has repeatedly resulted. In some of the reported cases the error lay in extravasation of dopamine from a peripheral venous infusion site; in others the dosage had been high and prolonged, or ergometrine had also been given. In cases of pre-existing vascular damage from arteriosclerosis, diabetes, Raynaud’s disease, or frostbite, particular care must be taken. If discoloration appears, the infusion should be stopped and phentolamine 5–10 mg given intravenously. Nitroprusside may fail to prevent the onset of gangrene.

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