[Q] cardiogenic shock with hypotension first??? DOBUTAMINE 5 vs DOPAMIN 5? [ ] uptodate. link

[ ] LINK ;
https://www.uptodate.com/contents/use-of-vasopressors-and-inotropes#H20


CARDIOGENIC SHOCK => DOBUTAMINE 3mcg!!!

if combination with sepsis => NE + DOBUTAMINE as goal.
                                                 May consider dopamine instead of dobutamine(more than 5mcg for
                                                 avoiding vasodilatation)!
=> BUT before decision, should consult CICU for central line placement for NE!


Dobutamine 3mcg (chronic hypotension.. slow progression)
Dobutamine is most frequently used in severe, medically refractory heart failure and cardiogenic shock and should not be routinely used in sepsis because of the risk of hypotension. Dobutamine does not selectively vasodilate the renal vascular bed, as dopamine does at low doses. (See "Inotropic agents in heart failure with reduced ejection fraction".)

vs

Dopamine 5mcg = more likely supporting Cardiac. (in urgent)

Low-dose: 1 to 5 mcg/kg/minute, results in increased renal blood flow and urine output. 

Intermediate-dose: 5 to 10 mcg/kg/minute, results in increased renal blood flow, heart rate, cardiac contractility, and cardiac output

High-dose: >10 mcg/kg/minute, alpha-adrenergic effects begin to predominate, resulting in vasoconstriction, increased blood pressure, in addition to increased heart rate, cardiac contractility, and cardiac output due to beta-adrenergic effects.