Which emergency drugs can be prepared as infusions? At what concentration (mg/mL) are they diluted—specifically in Normal Saline (NS)? For which specific diseases or conditions are they indicated? This covers their management within the ICU setting, including associated signs and symptoms.
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The library database queries didn't return direct results for infusion concentration tables. I'll now draw on authoritative clinical pharmacology knowledge to provide a comprehensive answer on ICU emergency drug infusions.
Emergency Drug Infusions in the ICU
Below is a comprehensive reference covering drugs commonly prepared as continuous infusions in the ICU/emergency setting, including their standard dilution concentrations in Normal Saline (0.9% NaCl), indications, and associated clinical features.
1. Vasopressors & Inotropes
Norepinephrine (Noradrenaline)
| Parameter | Detail |
|---|---|
| Concentration in NS | 4 mg in 50 mL NS = 0.08 mg/mL (8 mcg/mL); or 8 mg in 250 mL NS = 0.032 mg/mL |
| Dose range | 0.01–3 mcg/kg/min |
| Indications | Septic shock, distributive shock, vasodilatory shock post-cardiac surgery |
| Signs & Symptoms treated | Hypotension, tachycardia, warm extremities, widened pulse pressure, reduced SVR |
Epinephrine (Adrenaline)
| Parameter | Detail |
|---|---|
| Concentration in NS | 1 mg in 50 mL NS = 0.02 mg/mL (20 mcg/mL); or 5 mg in 250 mL = 0.02 mg/mL |
| Dose range | 0.01–1 mcg/kg/min |
| Indications | Anaphylactic shock, cardiogenic shock, refractory septic shock, cardiac arrest (bolus), post-resuscitation |
| Signs & Symptoms treated | Bronchospasm, urticaria, angioedema, hypotension, bradycardia, low cardiac output |
Dopamine
| Parameter | Detail |
|---|---|
| Concentration in NS | 200 mg in 250 mL NS = 0.8 mg/mL (800 mcg/mL) |
| Dose range | 2–20 mcg/kg/min |
| Indications | Cardiogenic shock, hemodynamically unstable bradycardia (moderate doses), symptomatic hypotension |
| Signs & Symptoms treated | Low cardiac output, bradycardia with hypotension; at low doses: urine output support (largely outdated) |
Dobutamine
| Parameter | Detail |
|---|---|
| Concentration in NS | 250 mg in 250 mL NS = 1 mg/mL (1000 mcg/mL) |
| Dose range | 2–20 mcg/kg/min |
| Indications | Cardiogenic shock, acute decompensated heart failure, sepsis with low cardiac output (adjunct) |
| Signs & Symptoms treated | Low ejection fraction, elevated filling pressures, pulmonary edema, cold extremities, elevated lactate |
Vasopressin
| Parameter | Detail |
|---|---|
| Concentration in NS | 20 units in 100 mL NS = 0.2 units/mL |
| Dose range | 0.01–0.04 units/min (fixed dose adjunct) |
| Indications | Refractory septic shock (adjunct to norepinephrine), vasodilatory shock, hepatorenal syndrome, variceal bleeding (IV bolus) |
| Signs & Symptoms treated | Refractory hypotension, high norepinephrine requirements, relative vasopressin deficiency in sepsis |
Phenylephrine
| Parameter | Detail |
|---|---|
| Concentration in NS | 100 mg in 250 mL NS = 0.4 mg/mL (400 mcg/mL) |
| Dose range | 0.5–6 mcg/kg/min |
| Indications | Distributive shock, hypotension during anesthesia (spinal/epidural), neurogenic shock, HOCM with hypotension |
| Signs & Symptoms treated | Hypotension with preserved cardiac output, reflex bradycardia management in tachyarrhythmias |
2. Antiarrhythmics
Amiodarone
| Parameter | Detail |
|---|---|
| Concentration in NS | 150 mg in 100 mL NS = 1.5 mg/mL (loading); maintenance 900 mg in 500 mL NS = 1.8 mg/mL |
| Dose | Load: 150 mg over 10 min, then 1 mg/min × 6 hr, then 0.5 mg/min × 18 hr |
| Indications | VF/pulseless VT (ACLS), hemodynamically stable VT, AF/flutter with rapid ventricular rate, WPW |
| Signs & Symptoms treated | Palpitations, wide-complex tachycardia, hemodynamic instability from arrhythmia, ECG: VT morphology |
Lignocaine (Lidocaine)
| Parameter | Detail |
|---|---|
| Concentration in NS | 500 mg in 250 mL NS = 2 mg/mL (2000 mcg/mL) |
| Dose | Bolus 1–1.5 mg/kg IV, then infusion 1–4 mg/min |
| Indications | VT/VF refractory to amiodarone, post-MI ventricular arrhythmias, local anesthesia adjunct |
| Signs & Symptoms treated | Ventricular ectopy, wide-complex tachycardia, ECG changes post-infarction |
Adenosine (bolus, not infusion)
Rapid IV push only — not prepared as an infusion.
Diltiazem
| Parameter | Detail |
|---|---|
| Concentration in NS | 125 mg in 125 mL NS = 1 mg/mL |
| Dose | 5–15 mg/hr infusion |
| Indications | AF/flutter with rapid ventricular response, PSVT (after conversion) |
| Signs & Symptoms treated | Rapid heart rate, palpitations, dyspnea, chest discomfort from rate-related ischemia |
3. Anticoagulants
Unfractionated Heparin (UFH)
| Parameter | Detail |
|---|---|
| Concentration in NS | 25,000 units in 250 mL NS = 100 units/mL |
| Dose | Bolus 60–80 units/kg, then 12–18 units/kg/hr; titrate by aPTT |
| Indications | ACS (NSTEMI/STEMI), pulmonary embolism, DVT, CRRT anticoagulation, AF with high stroke risk, mechanical valve |
| Signs & Symptoms treated | Thrombosis, chest pain + troponin rise, hypoxia + pleuritic pain (PE), leg swelling (DVT) |
4. Sedatives & Analgesics
Propofol
| Parameter | Detail |
|---|---|
| Preparation | Comes as ready emulsion (10 mg/mL); not further diluted in NS (lipid emulsion — incompatible with NS dilution) |
| Dose | 5–50 mcg/kg/min (sedation); higher for procedural anesthesia |
| Indications | ICU sedation, procedural sedation, status epilepticus (refractory) |
| Signs & Symptoms treated | Agitation, ventilator dyssynchrony, intracranial hypertension, refractory seizures |
Midazolam
| Parameter | Detail |
|---|---|
| Concentration in NS | 50 mg in 50 mL NS = 1 mg/mL |
| Dose | 0.02–0.1 mg/kg/hr |
| Indications | ICU sedation, status epilepticus, alcohol withdrawal seizures, procedural sedation |
| Signs & Symptoms treated | Agitation, seizure activity, delirium tremens (tremors, autonomic instability, seizures) |
Morphine
| Parameter | Detail |
|---|---|
| Concentration in NS | 50 mg in 50 mL NS = 1 mg/mL |
| Dose | 1–10 mg/hr infusion |
| Indications | Acute severe pain (trauma, post-op, cancer), dyspnea in acute pulmonary edema, ICU analgesia |
| Signs & Symptoms treated | Severe pain, respiratory distress, tachycardia from pain, acute cardiogenic pulmonary edema |
Fentanyl
| Parameter | Detail |
|---|---|
| Concentration in NS | 500 mcg in 50 mL NS = 10 mcg/mL |
| Dose | 25–200 mcg/hr |
| Indications | ICU analgesia (preferred in renal failure), procedural pain, hemodynamically unstable patients |
| Signs & Symptoms treated | Pain, tachycardia, hypertension from pain stimulus; superior to morphine in renal impairment |
Dexmedetomidine
| Parameter | Detail |
|---|---|
| Concentration in NS | 200 mcg in 50 mL NS = 4 mcg/mL |
| Dose | 0.2–1.5 mcg/kg/hr |
| Indications | ICU sedation (light-to-moderate), alcohol withdrawal, procedural sedation, facilitate weaning off ventilator |
| Signs & Symptoms treated | Agitation, sympathetic overactivity (withdrawal), delirium; advantage: preserves respiratory drive |
Ketamine
| Parameter | Detail |
|---|---|
| Concentration in NS | 500 mg in 50 mL NS = 10 mg/mL |
| Dose | 0.1–0.5 mg/kg/hr (infusion for pain/sedation) |
| Indications | Procedural sedation, bronchospasm (refractory asthma), hemodynamically unstable patients requiring sedation, burn pain |
| Signs & Symptoms treated | Severe bronchospasm (wheeze, hypoxia), hemodynamic instability needing sedation, refractory pain |
5. Neuromuscular Blocking Agents
Vecuronium
| Parameter | Detail |
|---|---|
| Concentration in NS | 10 mg in 100 mL NS = 0.1 mg/mL |
| Dose | 0.05–0.1 mg/kg/hr |
| Indications | ARDS (facilitate lung-protective ventilation), refractory ICP, status asthmaticus, therapeutic hypothermia |
| Signs & Symptoms treated | Ventilator dyssynchrony, high peak airway pressures, patient-ventilator asynchrony |
Cisatracurium
| Parameter | Detail |
|---|---|
| Concentration in NS | 200 mg in 100 mL NS = 2 mg/mL (preferred in organ failure — Hofmann elimination) |
| Dose | 0.03–0.06 mg/kg/hr |
| Indications | ARDS, organ failure patients requiring paralysis |
| Signs & Symptoms treated | Same as above; preferred when hepatic/renal function is impaired |
6. Antihypertensives
Sodium Nitroprusside
| Parameter | Detail |
|---|---|
| Concentration in NS | 50 mg in 250 mL NS = 0.2 mg/mL (light-protected) |
| Dose | 0.3–10 mcg/kg/min |
| Indications | Hypertensive emergencies, aortic dissection (with beta-blocker), acute severe heart failure |
| Signs & Symptoms treated | BP >180/120 + end-organ damage (encephalopathy, retinopathy, acute renal failure, stroke) |
Nitroglycerin (GTN)
| Parameter | Detail |
|---|---|
| Concentration in NS | 50 mg in 250 mL NS = 0.2 mg/mL (use non-PVC tubing) |
| Dose | 5–200 mcg/min |
| Indications | Acute coronary syndrome, acute decompensated heart failure with hypertension, hypertensive emergency |
| Signs & Symptoms treated | Chest pain, ST elevation/depression, pulmonary edema, elevated preload, cardiogenic pulmonary edema |
Labetalol
| Parameter | Detail |
|---|---|
| Concentration in NS | 200 mg in 200 mL NS = 1 mg/mL |
| Dose | 0.5–2 mg/min |
| Indications | Hypertensive emergency, aortic dissection, eclampsia/pre-eclampsia, pheochromocytoma crisis |
| Signs & Symptoms treated | Severe hypertension + neurological symptoms, severe headache, visual changes, proteinuria |
Hydralazine (intermittent bolus in practice, but can be infused)
| Parameter | Detail |
|---|---|
| Concentration in NS | 20 mg in 100 mL NS = 0.2 mg/mL |
| Dose | 10–40 mg IV bolus q4–6h or infusion |
| Indications | Pre-eclampsia, hypertensive emergency in pregnancy |
7. Bronchodilators
Salbutamol (Albuterol) — IV infusion
| Parameter | Detail |
|---|---|
| Concentration in NS | 5 mg in 500 mL NS = 0.01 mg/mL (10 mcg/mL) |
| Dose | 5–20 mcg/min |
| Indications | Life-threatening bronchospasm/status asthmaticus refractory to nebulized therapy, severe hyperkalemia |
| Signs & Symptoms treated | Severe wheeze, silent chest, hypoxia, hypercapnia, pulsus paradoxus; hyperkalemia (ECG changes) |
Aminophylline
| Parameter | Detail |
|---|---|
| Concentration in NS | 500 mg in 500 mL NS = 1 mg/mL |
| Dose | Load 5–6 mg/kg over 20–30 min, then 0.5–0.7 mg/kg/hr |
| Indications | Severe asthma, COPD exacerbation refractory to beta-agonists, apnea of prematurity |
| Signs & Symptoms treated | Bronchospasm, hypoxia, wheeze, respiratory fatigue; narrow therapeutic window (target 10–20 mg/L) |
8. Antiepileptics
Phenytoin / Fosphenytoin
| Parameter | Detail |
|---|---|
| Concentration in NS | 1000 mg in 100 mL NS = 10 mg/mL (max; must use NS — precipitates in dextrose) |
| Dose | Load 15–20 mg/kg at ≤50 mg/min (phenytoin); fosphenytoin at 150 mg PE/min |
| Indications | Status epilepticus (2nd line after benzodiazepines), seizure prophylaxis post-neurosurgery/TBI |
| Signs & Symptoms treated | Tonic-clonic seizures, refractory convulsions, post-traumatic seizures |
Levetiracetam
| Parameter | Detail |
|---|---|
| Concentration in NS | 1000–3000 mg in 100 mL NS = 10–30 mg/mL |
| Dose | 1000–3000 mg IV over 15 min |
| Indications | Status epilepticus (2nd/3rd line), seizure prophylaxis |
| Signs & Symptoms treated | Seizures, especially in hepatic failure patients (safer than phenytoin) |
9. Other Critical ICU Drugs
Insulin (Regular) — ICU infusion
| Parameter | Detail |
|---|---|
| Concentration in NS | 100 units in 100 mL NS = 1 unit/mL |
| Dose | Titrated per glucose protocol (usually 1–10 units/hr) |
| Indications | Hyperglycemia in critical illness, DKA, HHS, hyperkalemia (adjunct with dextrose) |
| Signs & Symptoms treated | BGL >10–11 mmol/L in ICU, polyuria, polydipsia, acidosis (DKA), altered consciousness (HHS) |
Magnesium Sulfate
| Parameter | Detail |
|---|---|
| Concentration in NS | 5 g in 100 mL NS = 50 mg/mL (loading); maintenance 1–2 g/hr in 100 mL |
| Dose | 4–6 g load over 15–20 min (eclampsia); 2 g IV for arrhythmia |
| Indications | Eclampsia/pre-eclampsia, Torsades de Pointes, hypomagnesemia, severe asthma, refractory arrhythmia |
| Signs & Symptoms treated | Seizures in pregnancy, hypertension + proteinuria, polymorphic VT (QTc prolongation), bronchospasm |
Potassium Chloride (KCl)
| Parameter | Detail |
|---|---|
| Concentration in NS | 40 mmol in 100 mL NS = 0.4 mmol/mL (via central line, max 20 mmol/hr) |
| Indications | Hypokalemia (K⁺ < 3.0 mEq/L), especially with arrhythmias, DKA, diuretic-related loss |
| Signs & Symptoms treated | Muscle weakness, ileus, cardiac arrhythmias (PVCs, VT), flat T-waves + U-waves on ECG |
Sodium Bicarbonate
| Parameter | Detail |
|---|---|
| Concentration in NS | 8.4% (1 mmol/mL) — often given as isotonic solution (150 mEq in 1L NS) |
| Dose | 1–2 mEq/kg IV bolus; infusion titrated to pH |
| Indications | Severe metabolic acidosis (pH <7.1), TCA overdose, hyperkalemia, uremia |
| Signs & Symptoms treated | Kussmaul breathing, altered consciousness, QRS widening (TCA), hyperkalemia-related arrhythmias |
N-Acetylcysteine (NAC)
| Parameter | Detail |
|---|---|
| Concentration in NS | 150 mg/kg in 200 mL NS (3-bag Prescott protocol, bag 1) |
| Dose | 150 mg/kg over 1 hr → 50 mg/kg over 4 hr → 100 mg/kg over 16 hr |
| Indications | Paracetamol (acetaminophen) overdose, contrast nephropathy prophylaxis, fulminant hepatic failure |
| Signs & Symptoms treated | Elevated LFTs, jaundice, coagulopathy, hepatic encephalopathy, elevated paracetamol levels |
Summary Quick-Reference Table
| Drug | NS Concentration | Primary ICU Indication |
|---|---|---|
| Norepinephrine | 8 mcg/mL | Septic shock |
| Epinephrine | 20 mcg/mL | Anaphylaxis, cardiac arrest |
| Dopamine | 800 mcg/mL | Cardiogenic shock |
| Dobutamine | 1000 mcg/mL | Cardiogenic shock / LV failure |
| Vasopressin | 0.2 units/mL | Refractory vasodilatory shock |
| Phenylephrine | 400 mcg/mL | Distributive shock (pure vasopressor) |
| Amiodarone | 1.5–1.8 mg/mL | VT/VF, AF |
| Lidocaine | 2 mg/mL | Ventricular arrhythmias |
| Diltiazem | 1 mg/mL | AF/flutter rate control |
| Heparin (UFH) | 100 units/mL | ACS, PE, DVT, CRRT |
| Midazolam | 1 mg/mL | ICU sedation, status epilepticus |
| Fentanyl | 10 mcg/mL | ICU analgesia |
| Dexmedetomidine | 4 mcg/mL | ICU sedation (cooperative) |
| Ketamine | 10 mg/mL | Sedation-analgesia, asthma |
| Cisatracurium | 2 mg/mL | ARDS paralysis |
| Nitroprusside | 0.2 mg/mL | Hypertensive emergency |
| Nitroglycerin (GTN) | 0.2 mg/mL | ACS, acute heart failure |
| Labetalol | 1 mg/mL | Hypertensive emergency |
| Salbutamol IV | 10 mcg/mL | Status asthmaticus |
| Aminophylline | 1 mg/mL | Severe asthma/COPD |
| Phenytoin | 10 mg/mL | Status epilepticus (NS only) |
| Magnesium sulfate | 50 mg/mL | Eclampsia, Torsades |
| Insulin (Regular) | 1 unit/mL | DKA, hyperglycemia, hyperkalemia |
| KCl | 0.4 mmol/mL | Hypokalemia with arrhythmia |
| NAC | Protocol-based | Paracetamol overdose |
Key Clinical Notes:
- Central line required for vasopressors (norepinephrine, epinephrine, vasopressin), concentrated KCl, and amiodarone (peripheral infiltration causes necrosis).
- Phenytoin must only be diluted in NS — precipitates in glucose-containing solutions.
- Nitroglycerin adsorbs to PVC tubing — use polyethylene or glass infusion sets.
- Nitroprusside is light-sensitive — wrap bag and tubing in foil; watch for cyanide toxicity with prolonged use or high doses.
- Propofol is an emulsion — cannot be diluted in NS; monitor for Propofol Infusion Syndrome (PRIS) with prolonged high-dose use.
- Always titrate vasopressors and sedatives using validated ICU scoring systems (MAP targets, RASS scores, CPOT for pain).
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