Infusions can be prepared using 30 different types of emergency drugs. This covers the specific concentrations (mg/mL) and the manner in which they are diluted in Normal Saline (NS). It also details the specific diseases or conditions for which these infusions are indicated, their role in ICU management, and associated signs and symptoms.
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The XLSX is ready for download:
Emergency Drug Infusions ICU
Spreadsheet · XLSX
What's included
The spreadsheet contains 30 emergency drug infusions across 9 columns, color-coded and formatted for ICU reference use:
| Col | Content |
|---|---|
| No. | Sequential number (1–30) |
| Drug Name | Generic name |
| Drug Class | Mechanism class (italic, navy) |
| Standard Concentration | mg/mL or units/mL as prepared |
| Dilution in NS | Volume of NS, final concentration |
| Usual Dose / Rate | IV bolus and/or infusion rate |
| Indications | Specific diseases/conditions (red text) |
| ICU Role / Management | Role in ICU, targets, monitoring notes |
| Signs & Symptoms Treated | Clinical presentation prompting the drug |
The 30 drugs covered
| # | Drug | Class |
|---|---|---|
| 1 | Norepinephrine | Vasopressor |
| 2 | Epinephrine | Vasopressor / Inotrope |
| 3 | Dopamine | Vasopressor / Inotrope |
| 4 | Dobutamine | Inotrope |
| 5 | Vasopressin | Vasopressor (V1) |
| 6 | Phenylephrine | Pure Alpha-1 vasopressor |
| 7 | Amiodarone | Antiarrhythmic Class III |
| 8 | Lidocaine | Antiarrhythmic Class Ib |
| 9 | Labetalol | Alpha + Beta blocker |
| 10 | Nicardipine | CCB antihypertensive |
| 11 | Sodium Nitroprusside | Balanced vasodilator |
| 12 | Nitroglycerin | Venodilator / Nitrate |
| 13 | Heparin (UFH) | Anticoagulant |
| 14 | Regular Insulin | Antihyperglycemic |
| 15 | D50W + Insulin | Hyperkalemia Rx |
| 16 | Morphine | Opioid analgesic |
| 17 | Fentanyl | Short-acting opioid |
| 18 | Midazolam | Benzodiazepine sedative |
| 19 | Propofol | GABA-A sedative |
| 20 | Dexmedetomidine | Alpha-2 agonist sedative |
| 21 | Ketamine | Dissociative anesthetic |
| 22 | Hydralazine | Direct arteriolar vasodilator |
| 23 | Magnesium Sulfate | Anticonvulsant / Antiarrhythmic |
| 24 | Adenosine | AV nodal blocker |
| 25 | Calcium Gluconate/Chloride | Cardiac membrane stabilizer |
| 26 | Sodium Bicarbonate | Alkalinizing agent |
| 27 | Furosemide | Loop diuretic |
| 28 | Potassium Chloride | Electrolyte replacement |
| 29 | Alteplase (tPA) | Thrombolytic |
| 30 | Naloxone | Opioid antagonist |
Important: Always verify against your institution's current formulary, pharmacy protocols, and patient-specific parameters before clinical use.
What types of emergency drugs can be prepared as infusions? At what concentration (mg/mL) are they diluted in Normal Saline (NS)? For which specific diseases or conditions are these infusions indicated? This covers their management within the ICU setting, including associated signs and symptoms.
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Good textbook content retrieved. Now I have authoritative clinical information. Let me deliver the comprehensive answer drawing on the textbook findings plus established pharmacology knowledge for all 30 drugs.
Emergency Drug Infusions — ICU Reference Guide
Below is a comprehensive reference covering 30 emergency drugs commonly prepared as intravenous infusions in the ICU. Each entry covers: drug class, standard concentration in Normal Saline (NS), usual dose/rate, indications, ICU management role, and associated signs & symptoms.
🔴 VASOPRESSORS
1. Norepinephrine (Levophed)
Class: Alpha-1 >> Beta-1 adrenergic agonist
| Parameter | Details |
|---|---|
| Concentration in NS | 4–8 mg in 250 mL NS → 0.016–0.032 mg/mL |
| Usual dose | 0.01–3 mcg/kg/min IV; start at 2–4 mcg/min, titrate to MAP ≥ 65 mmHg |
| Indications | Septic shock, distributive/vasodilatory shock, neurogenic shock |
| ICU role | First-line vasopressor in septic shock per Surviving Sepsis Campaign guidelines. Increases SVR via alpha-1 activation. Moderate inotropic effect via beta-1. — Harrison's Principles of Internal Medicine 22E, p. 2371 |
| Signs & symptoms | Warm flushed skin, wide pulse pressure, bounding pulse, hypotension, altered mental status (distributive shock) |
2. Epinephrine (Adrenaline)
Class: Alpha + Beta adrenergic agonist
| Parameter | Details |
|---|---|
| Concentration in NS | 4 mg in 100 mL NS → 0.04 mg/mL; or 2–8 mg in 250 mL NS |
| Usual dose | 0.01–1 mcg/kg/min IV; cardiac arrest: 1 mg IV bolus q3–5 min |
| Indications | Cardiac arrest (VF/PVT/asystole/PEA), anaphylaxis, refractory septic shock, severe bradycardia |
| ICU role | Second-line vasopressor; raises BP, HR, and cardiac output. Associated with higher lactate and more arrhythmias than norepinephrine in CS. Preferred agent for anaphylaxis. — Harrison's, p. 2371 |
| Signs & symptoms | Cardiac arrest (no pulse), anaphylaxis (urticaria, angioedema, bronchospasm, hypotension), severe bradycardia, circulatory collapse |
3. Dopamine
Class: Dose-dependent dopaminergic / beta-1 / alpha-1 agonist
| Parameter | Details |
|---|---|
| Concentration in NS | 200–400 mg in 250–500 mL NS → 0.8–1.6 mg/mL |
| Usual dose | 2–20 mcg/kg/min IV (dose-dependent effects) |
| Indications | Cardiogenic shock (when norepinephrine unavailable), symptomatic bradycardia unresponsive to atropine, post-cardiac surgery low output states |
| ICU role | Low dose (2–5 mcg/kg/min): renal/splanchnic vasodilation. Mid dose (5–10): cardiac inotrope. High dose (>10): vasopressor. Should be avoided as first-line in MI-related CS due to proarrhythmogenic effects. — Harrison's, p. 2371 |
| Signs & symptoms | Cardiogenic shock: cool extremities, oliguria, hypotension, elevated JVP. Bradycardia: hemodynamic instability |
4. Vasopressin (ADH / Pitressin)
Class: V1 receptor agonist — non-catecholamine vasopressor
| Parameter | Details |
|---|---|
| Concentration in NS | 20 units in 50 mL NS → 0.4 units/mL |
| Usual dose | 0.01–0.04 units/min IV (fixed dose — do not titrate) |
| Indications | Septic shock (adjunct to norepinephrine), catecholamine-resistant vasodilatory shock, central diabetes insipidus |
| ICU role | Added to norepinephrine to spare catecholamine doses; causes vasoconstriction via V1 receptors on vascular smooth muscle; no direct inotropic effect |
| Signs & symptoms | Refractory hypotension despite high-dose norepinephrine, vasodilatory state |
5. Phenylephrine
Class: Pure alpha-1 adrenergic agonist
| Parameter | Details |
|---|---|
| Concentration in NS | 100 mg in 250 mL NS → 0.4 mg/mL |
| Usual dose | 0.5–6 mcg/kg/min IV infusion; or 50–200 mcg IV bolus |
| Indications | Hypotension without tachycardia, LVOTO (hypertrophic cardiomyopathy), spinal/neurogenic shock, SVT (vagal reflex termination) |
| ICU role | Raises SVR without increasing HR (causes reflex bradycardia); preferred when tachycardia is harmful (e.g., LVOTO, post-cardiac surgery) |
| Signs & symptoms | Hypotension, reflexive tachycardia (offset by phenylephrine), LVOTO-related syncope/dyspnea |
🟠 INOTROPES
6. Dobutamine
Class: Synthetic beta-1 (predominant) + beta-2 agonist
| Parameter | Details |
|---|---|
| Concentration in NS | 250 mg in 250 mL NS → 1 mg/mL |
| Usual dose | 2–20 mcg/kg/min IV; start at 2.5 mcg/kg/min |
| Indications | Cardiogenic shock, acute decompensated heart failure (ADHF), low cardiac output states post-cardiac surgery |
| ICU role | Positive inotrope with vasodilatory activity; increases CO; reduces afterload. Does not significantly raise SVR so often combined with a vasopressor in severe CS. Minimal chronotropic effect at low doses. — Harrison's, p. 2371 |
| Signs & symptoms | S3 gallop, cold extremities, elevated JVP/PCWP, pulmonary edema, oliguria (low-output state) |
7. Milrinone
Class: Phosphodiesterase-3 inhibitor (inodilator)
| Parameter | Details |
|---|---|
| Concentration in NS | 20 mg in 100 mL NS → 0.2 mg/mL |
| Usual dose | 0.375–0.75 mcg/kg/min IV (no loading dose in ICU typically) |
| Indications | Cardiogenic shock (especially post-cardiac surgery), ADHF refractory to other agents, RV failure, pulmonary hypertension |
| ICU role | Increases cAMP → positive inotropy + vasodilation. Not shown to be superior to dobutamine. Causes significant hypotension. — Harrison's, p. 2371 |
| Signs & symptoms | Low CO state, refractory heart failure, elevated filling pressures, pulmonary hypertension with RV failure |
🟡 ANTIARRHYTHMICS
8. Amiodarone
Class: Class III antiarrhythmic (K+ channel blocker; also Na+, Ca2+, beta-blocker activity)
| Parameter | Details |
|---|---|
| Concentration in NS | Loading: 150 mg in 100 mL NS → 1.5 mg/mL over 10 min. Maintenance: 900 mg in 500 mL NS → 1.8 mg/mL (1 mg/min × 6 h, then 0.5 mg/min × 18 h) |
| Usual dose | 150 mg IV over 10 min; then 1 mg/min × 6 h; then 0.5 mg/min × 18 h |
| Indications | Refractory VF/pulseless VT (ACLS), hemodynamically stable VT, AF with RVR, SVT |
| ICU role | Broadest-spectrum antiarrhythmic; first-line for shock-refractory VF/VT in ACLS. Prolongs QT. Risk of pulmonary toxicity, thyroid dysfunction, hepatotoxicity long-term |
| Signs & symptoms | Pulseless VT/VF (cardiac arrest), hemodynamically unstable tachycardia, wide-complex tachycardia, AF with rapid ventricular response |
9. Lidocaine
Class: Class Ib antiarrhythmic (Na+ channel blocker)
| Parameter | Details |
|---|---|
| Concentration in NS | 2 g in 250 mL NS → 8 mg/mL |
| Usual dose | 1–1.5 mg/kg IV bolus; maintenance infusion 1–4 mg/min |
| Indications | VT, VF (if amiodarone unavailable), ventricular ectopy, status epilepticus (alternative) |
| ICU role | Membrane stabilizer; suppresses ventricular ectopy. Used in ACLS if amiodarone is unavailable. Toxicity: perioral numbness, tremor, seizures, bradycardia |
| Signs & symptoms | VT/VF, frequent PVCs, wide-complex tachycardia, ventricular ectopy |
10. Adenosine
Class: Endogenous nucleoside / Class V antiarrhythmic (AV nodal blocker)
| Parameter | Details |
|---|---|
| Concentration in NS | Undiluted — 6 mg/2 mL rapid IV push; follow immediately with 20 mL NS flush |
| Usual dose | 6 mg rapid IV push; repeat 12 mg × 2 if no response |
| Indications | PSVT (AVNRT, AVRT), diagnostic evaluation of wide-complex tachycardia |
| ICU role | Transiently blocks AV node, terminates re-entrant tachycardias; half-life < 10 seconds; must be given via large proximal vein with immediate flush |
| Signs & symptoms | Sudden-onset regular tachycardia (HR 150–250), palpitations, dizziness, near-syncope, chest discomfort |
11. Magnesium Sulfate
Class: Electrolyte / antiarrhythmic / anticonvulsant
| Parameter | Details |
|---|---|
| Concentration in NS | Loading: 4 g in 100 mL NS → 40 mg/mL over 15–20 min. Maintenance: 1–2 g/h in 100 mL NS/h |
| Usual dose | Loading 4–6 g IV over 15–20 min; maintenance 1–2 g/h |
| Indications | Eclampsia/pre-eclampsia (seizure prevention and treatment), Torsades de Pointes (TdP), severe acute asthma, hypomagnesemia, digitalis toxicity |
| ICU role | Anticonvulsant of choice in eclampsia; corrects Mg deficit driving TdP; bronchodilator in refractory asthma. Monitor Mg levels, respiratory rate, patellar reflex. Antidote: calcium gluconate |
| Signs & symptoms | Eclampsia: severe HTN, headache, visual changes, seizures, proteinuria. TdP: polymorphic VT, QTc prolongation. Asthma: refractory bronchospasm, wheeze |
🟢 ANTIHYPERTENSIVES / VASODILATORS
12. Labetalol
Class: Non-selective alpha + beta blocker
| Parameter | Details |
|---|---|
| Concentration in NS | 200 mg in 200 mL NS → 1 mg/mL |
| Usual dose | 0.5–2 mg/min IV infusion; or 20 mg IV bolus q10 min (max 300 mg total) |
| Indications | Hypertensive emergency, aortic dissection, hypertensive encephalopathy, eclampsia |
| ICU role | Controlled BP reduction without reflex tachycardia; preferred in aortic dissection (reduces aortic wall stress). Contraindicated in acute decompensated HF and reactive airways disease |
| Signs & symptoms | Severe headache, blurred vision, altered consciousness, focal neurological deficits, aortic dissection (tearing chest/back pain) |
13. Nicardipine
Class: Dihydropyridine calcium channel blocker
| Parameter | Details |
|---|---|
| Concentration in NS | 25 mg in 250 mL NS → 0.1 mg/mL |
| Usual dose | 5–15 mg/h IV; titrate by 2.5 mg/h q5–15 min |
| Indications | Hypertensive emergency, subarachnoid hemorrhage (SAH), perioperative hypertension, hypertensive encephalopathy |
| ICU role | Smooth, titratable BP control; cerebral vasodilation; preferred in neurological emergencies. Does not affect HR significantly |
| Signs & symptoms | Hypertensive encephalopathy, intracranial hemorrhage, SAH (sudden severe "thunderclap" headache), post-op hypertension |
14. Sodium Nitroprusside
Class: Balanced arteriolar + venous vasodilator (releases NO)
| Parameter | Details |
|---|---|
| Concentration in NS | 50 mg in 250 mL NS → 0.2 mg/mL; protect from light (aluminum foil-wrap bag/tubing) |
| Usual dose | 0.3–10 mcg/kg/min IV; start low, titrate carefully |
| Indications | Hypertensive crisis, acute aortic dissection, severe acute MR/AR (afterload reduction), cardiogenic shock (afterload reduction) |
| ICU role | Potent balanced vasodilator; reduces both preload and afterload. Risk of cyanide toxicity (especially > 48 h or renal failure) — monitor thiocyanate levels. Tachyphylaxis may occur |
| Signs & symptoms | Malignant hypertension (papilledema, end-organ damage), aortic dissection, acute valvular regurgitation; cyanide toxicity: metabolic acidosis, altered consciousness, seizures |
15. Nitroglycerin (GTN)
Class: Organic nitrate — venodilator / coronary vasodilator
| Parameter | Details |
|---|---|
| Concentration in NS | 50 mg in 250–500 mL NS → 0.1–0.2 mg/mL; use glass bottle — adsorbs to PVC |
| Usual dose | 5–200 mcg/min IV; titrate every 3–5 min |
| Indications | Acute coronary syndrome (ACS), acute pulmonary edema, hypertensive emergency with ACS, vasospastic angina |
| ICU role | Reduces preload; dilates coronary arteries; decreases PCWP; relieves ischemic chest pain. Avoid if systolic BP < 90 mmHg or if phosphodiesterase inhibitor used |
| Signs & symptoms | Ischemic chest pain, ST elevation/depression, acute pulmonary edema (orthopnea, pink frothy sputum), elevated PCWP |
16. Hydralazine
Class: Direct arteriolar vasodilator
| Parameter | Details |
|---|---|
| Concentration in NS | 20 mg in 100 mL NS → 0.2 mg/mL |
| Usual dose | 5–20 mg IV bolus q4–6 h; or 0.1–0.5 mg/kg/dose |
| Indications | Hypertensive emergency in pregnancy, eclampsia/pre-eclampsia, acute heart failure (afterload reduction) |
| ICU role | Reduces afterload; safe in pregnancy; causes reflex tachycardia (give with beta-blocker in non-obstetric use). Onset 10–20 min; duration 2–4 h |
| Signs & symptoms | Severe HTN in pregnancy, eclampsia: headache, visual disturbance, proteinuria, seizures, severe hypertension (BP > 160/110) |
🔵 SEDATIVES / ANALGESICS / ANESTHETICS
17. Propofol
Class: General anesthetic / sedative (GABA-A agonist)
| Parameter | Details |
|---|---|
| Concentration in NS | Undiluted — 10 mg/mL (1% lipid emulsion); do NOT dilute in NS; use dedicated IV line |
| Usual dose | Sedation: 5–50 mcg/kg/min IV; change vial/tubing every 12 h (infection risk) |
| Indications | ICU sedation (mechanically ventilated patients), refractory status epilepticus, procedural sedation, RSI induction |
| ICU role | Preferred for ICU sedation due to rapid on/offset — facilitates daily awakening trials. Lowers ICP. Risk of Propofol Infusion Syndrome (PRIS) with high doses > 48 h (metabolic acidosis, rhabdomyolysis, cardiac failure) |
| Signs & symptoms | Agitation on ventilator, raised ICP (GCS ↓, pupillary changes), refractory seizures |
18. Midazolam
Class: Benzodiazepine (GABA-A positive modulator)
| Parameter | Details |
|---|---|
| Concentration in NS | 50 mg in 100 mL NS → 0.5 mg/mL |
| Usual dose | 0.02–0.1 mg/kg/h infusion; 1–5 mg IV bolus for procedural sedation |
| Indications | ICU sedation, status epilepticus, procedural sedation, alcohol withdrawal, tetanus |
| ICU role | Rapid onset, short duration, amnesia. First-line for status epilepticus in many protocols. Risk of accumulation in renal failure (active metabolite). Associated with more ICU delirium than dexmedetomidine |
| Signs & symptoms | Agitation, seizures, alcohol withdrawal (diaphoresis, tremor, tachycardia, hypertension, hallucinations — CIWA > 10) |
19. Dexmedetomidine (Precedex)
Class: Alpha-2 adrenergic agonist — sedative/analgesic
| Parameter | Details |
|---|---|
| Concentration in NS | 200 mcg in 50 mL NS → 4 mcg/mL |
| Usual dose | 0.2–1.5 mcg/kg/h IV; optional loading 1 mcg/kg over 10 min |
| Indications | ICU sedation (light, cooperative), alcohol/drug withdrawal, post-op shivering, opioid-sparing analgesia, weaning facilitation |
| ICU role | Cooperative "rousable" sedation without respiratory depression — ideal for ABCDE bundle and ventilator weaning. Reduces opioid and BZD requirements. Can cause bradycardia and hypotension |
| Signs & symptoms | Agitation, delirium, alcohol/opioid withdrawal, prevention of ICU delirium |
20. Ketamine
Class: Dissociative anesthetic / analgesic (NMDA receptor antagonist)
| Parameter | Details |
|---|---|
| Concentration in NS | 500 mg in 500 mL NS → 1 mg/mL (infusion); undiluted (50 mg/mL) for IV push induction |
| Usual dose | Induction: 1–2 mg/kg IV bolus; infusion: 0.1–0.5 mg/kg/h; analgesia: 0.1–0.3 mg/kg/h |
| Indications | RSI in hypotensive or asthmatic patients, procedural sedation, refractory bronchospasm, acute pain (analgesic doses), status asthmaticus |
| ICU role | Bronchodilator; preserves airway reflexes and hemodynamics; ideal for hypotensive trauma or asthma requiring intubation. Analgesic at sub-anesthetic doses (opioid-sparing). Give with benzodiazepine to reduce emergence phenomena |
| Signs & symptoms | Severe asthma (bronchospasm, air-trapping, hypercapnia), hypotensive trauma, severe acute pain, status asthmaticus |
21. Morphine Sulfate
Class: Mu-opioid agonist
| Parameter | Details |
|---|---|
| Concentration in NS | 50 mg in 50 mL NS → 1 mg/mL |
| Usual dose | 1–5 mg IV bolus; infusion 1–5 mg/h titrated to effect |
| Indications | Moderate-to-severe pain, acute pulmonary edema (dyspnea relief), post-operative analgesia, palliative care |
| ICU role | Analgesia, anxiolysis; preload reduction in acute pulmonary edema. Avoid in renal failure (active metabolite M6G accumulates). Causes histamine release |
| Signs & symptoms | Severe pain, dyspnea, acute pulmonary edema (orthopnea, pink frothy sputum, SpO2 ↓), tachycardia |
22. Fentanyl
Class: Synthetic mu-opioid agonist (short-acting)
| Parameter | Details |
|---|---|
| Concentration in NS | 500–1000 mcg in 100 mL NS → 5–10 mcg/mL |
| Usual dose | 25–100 mcg IV bolus; infusion 25–200 mcg/h |
| Indications | ICU analgesia, procedural sedation, intubation premedication, pain management in renal failure |
| ICU role | Preferred opioid in ICU — rapid onset, short duration, no histamine release, renal-safe (no active metabolites). First-choice for analgesia in mechanically ventilated patients |
| Signs & symptoms | Acute pain, agitation, dyspnea; preferred over morphine in renal failure or hemodynamic instability |
🟣 ANTICOAGULANTS / THROMBOLYTICS
23. Heparin (Unfractionated — UFH)
Class: Indirect thrombin inhibitor (activates antithrombin III)
| Parameter | Details |
|---|---|
| Concentration in NS | 25,000 units in 250 mL NS → 100 units/mL |
| Usual dose | 80 units/kg IV bolus, then 18 units/kg/h; adjust per aPTT protocol (target 60–100 s) |
| Indications | DVT/PE (treatment), ACS (NSTEMI/STEMI), AF anticoagulation, ECMO, cardiopulmonary bypass, mechanical valves |
| ICU role | Prevents clot propagation; monitor aPTT q6 h until stable. Antidote: protamine sulfate. Complication: HIT (heparin-induced thrombocytopenia) — check platelet count |
| Signs & symptoms | DVT (unilateral limb swelling, warmth, pain), PE (acute dyspnea, tachycardia, pleuritic chest pain, hypoxia, hypotension), ACS (chest pain, ST changes) |
24. Alteplase (tPA)
Class: Recombinant tissue plasminogen activator (thrombolytic)
| Parameter | Details |
|---|---|
| Concentration in NS | Reconstitute with supplied diluent to 1 mg/mL; then dilute: 90% in 100 mL NS over 60 min |
| Usual dose | Ischemic stroke: 0.9 mg/kg (max 90 mg) — 10% as IV bolus, 90% over 60 min. Massive PE: 100 mg over 2 h. STEMI: 15 mg bolus then infusion |
| Indications | Acute ischemic stroke (< 4.5 h from onset), massive PE with hemodynamic compromise, STEMI (if PCI unavailable) |
| ICU role | Dissolves thrombus and restores perfusion; strict contraindication checklist (hemorrhagic stroke, recent surgery, active bleeding). Monitor for intracranial hemorrhage post-administration |
| Signs & symptoms | Stroke: sudden focal deficit, aphasia, facial droop, hemiplegia. PE: acute dyspnea, syncope, obstructive shock, RV strain on ECG. STEMI: chest pain, ST elevation |
⚪ ELECTROLYTES / METABOLIC AGENTS
25. Regular Insulin
Class: Hormone / antihyperglycemic
| Parameter | Details |
|---|---|
| Concentration in NS | 100 units in 100 mL NS → 1 unit/mL; flush IV tubing with 50 mL before use (insulin adsorbs to PVC) |
| Usual dose | DKA: 0.05–0.1 units/kg/h; ICU glycemic control: titrate to glucose 140–180 mg/dL; hyperkalemia: 10 units IV bolus |
| Indications | DKA, HHS, ICU hyperglycemia (stress hyperglycemia), hyperkalemia (acute management) |
| ICU role | Drives glucose into cells (anabolic); drives K+ intracellularly in hyperkalemia (give with dextrose); tight glycemic control improves ICU outcomes; monitor glucose q1–2 h |
| Signs & symptoms | DKA: polyuria, polydipsia, vomiting, Kussmaul breathing, fruity breath, anion-gap acidosis, altered consciousness. Hyperkalemia: peaked T-waves, wide QRS, bradycardia |
26. Potassium Chloride (KCl)
Class: Electrolyte replacement
| Parameter | Details |
|---|---|
| Concentration in NS | 40 mEq in 100 mL NS → 0.4 mEq/mL (peripheral max); 40 mEq in 100–150 mL NS over 4 h |
| Usual dose | 10–20 mEq/h peripheral (max); up to 40 mEq/h central (life-threatening hypokalemia); must be on cardiac monitor |
| Indications | Hypokalemia (K+ < 3.5 mEq/L), DKA K+ replacement (insulin drives K+ intracellularly), digoxin toxicity prevention, hypokalemia-induced arrhythmias |
| ICU role | Never give undiluted IV bolus (cardiac arrest risk). Replace via central line for rates > 10 mEq/h. Replace Mg simultaneously (hypomagnesemia causes refractory hypokalemia) |
| Signs & symptoms | Weakness, ileus, flattened T-waves, U-waves, PVCs, VT, respiratory muscle failure (severe), rhabdomyolysis |
27. Magnesium Sulfate (see also #11 antiarrhythmic above)
(dual listing — also see antiarrhythmics)
28. Sodium Bicarbonate
Class: Alkalinizing agent / buffer
| Parameter | Details |
|---|---|
| Concentration in NS | 8.4% solution = 1 mEq/mL; for infusion: 100 mEq in 500 mL D5W (hypotonic); do NOT mix with calcium (precipitates) |
| Usual dose | 1–2 mEq/kg IV bolus (cardiac arrest specific indications); 50–150 mEq/h infusion for acidosis/urinary alkalinization |
| Indications | Severe metabolic acidosis (pH < 7.1 with hemodynamic compromise), TCA overdose (widens QRS — sodium loading), hyperkalemia (temporizing), urinary alkalinization (rhabdomyolysis, salicylate poisoning), cardiac arrest with hyperkalemia or TCA |
| ICU role | Raises serum pH; sodium loading narrows QRS in TCA toxicity; shifts K+ intracellularly; alkalinizes urine to prevent myoglobin precipitation in rhabdomyolysis |
| Signs & symptoms | Metabolic acidosis: Kussmaul breathing, altered consciousness. TCA: wide QRS, hypotension, seizures, arrhythmias. Hyperkalemia: ECG changes, cardiac arrest. Rhabdomyolysis: dark urine, elevated CK, AKI |
29. Calcium Gluconate / Calcium Chloride
Class: Electrolyte / cardiac membrane stabilizer
| Parameter | Details |
|---|---|
| Concentration in NS | 10% solution = 100 mg/mL; 1–2 g in 100 mL NS for infusion; can give undiluted slow IV push (emergency) |
| Usual dose | 1 g (10 mL of 10% calcium gluconate) IV over 3–5 min; infusion: 0.5–1 g/h; calcium chloride (3× more elemental Ca) preferred in cardiac arrest |
| Indications | Hyperkalemia (cardiac stabilization), hypocalcemia (tetany, QTc prolongation), calcium channel blocker overdose, hypermagnesemia, massive blood transfusion |
| ICU role | Stabilizes cardiac membrane in hyperkalemia (does NOT lower K+ level — temporizing); corrects ionized Ca deficit; reverses CCB toxicity and hypermagnesemia. Give via central line (tissue necrosis if extravasation) |
| Signs & symptoms | Hyperkalemia: peaked T-waves, wide QRS, sine wave, cardiac arrest. Hypocalcemia: tetany (Chvostek's/Trousseau's), perioral numbness, prolonged QTc, seizures, stridor |
🟤 DIURETICS
30. Furosemide (Frusemide)
Class: Loop diuretic (Na-K-2Cl transporter inhibitor, thick ascending limb)
| Parameter | Details |
|---|---|
| Concentration in NS | 250–500 mg in 250–500 mL NS → 1 mg/mL continuous infusion |
| Usual dose | Bolus: 20–200 mg IV over 2 min; Infusion: 5–40 mg/h; may require doubling in renal failure |
| Indications | Acute pulmonary edema (APE), fluid overload/anasarca, hypertensive emergency, AKI (convert oliguric to non-oliguric), hypercalcemia, hyperkalemia (promotes kaliuresis) |
| ICU role | Rapidly reduces preload in APE; promotes natriuresis and diuresis; continuous infusion superior to intermittent bolus in acute decompensated HF; replace K+ and Mg during therapy |
| Signs & symptoms | APE: orthopnea, PND, bibasal crackles, SpO2 ↓, S3 gallop, frothy sputum. Fluid overload: pitting edema, ascites, elevated JVP. Hypercalcemia: nausea, confusion, polyuria, "bones, stones, groans, thrones" |
🔶 REVERSAL AGENTS
31. Naloxone (Narcan)
Class: Competitive mu-opioid receptor antagonist
| Parameter | Details |
|---|---|
| Concentration in NS | Infusion: 2 mg in 500 mL NS → 0.004 mg/mL; bolus: 0.4 mg undiluted IV push |
| Usual dose | Bolus: 0.4–2 mg IV q2–3 min (max 10 mg); Infusion: give 2/3 of effective bolus dose per hour |
| Indications | Opioid overdose, opioid-induced respiratory depression, post-procedural opioid reversal |
| ICU role | Rapid reversal of opioid toxidrome; infusion required for long-acting opioids (methadone, fentanyl patch). Titrate to respiratory rate — not full reversal (avoid acute withdrawal and pain crisis). Duration of naloxone < most opioids — watch for re-narcotization |
| Signs & symptoms | Respiratory depression (RR < 12), miosis (pinpoint pupils), altered consciousness/coma, cyanosis, bradycardia — the "opioid toxidrome" |
Summary Table
| # | Drug | Standard Concentration in NS | Key Indication | ICU Priority |
|---|---|---|---|---|
| 1 | Norepinephrine | 0.016–0.032 mg/mL | Septic shock | ★★★★★ |
| 2 | Epinephrine | 0.04 mg/mL | Cardiac arrest, anaphylaxis | ★★★★★ |
| 3 | Dopamine | 0.8–1.6 mg/mL | Cardiogenic shock, bradycardia | ★★★★ |
| 4 | Vasopressin | 0.4 units/mL | Refractory septic shock | ★★★★ |
| 5 | Phenylephrine | 0.4 mg/mL | SVT, LVOTO, neurogenic shock | ★★★ |
| 6 | Dobutamine | 1 mg/mL | Cardiogenic shock, ADHF | ★★★★★ |
| 7 | Milrinone | 0.2 mg/mL | RV failure, post-cardiac surgery | ★★★★ |
| 8 | Amiodarone | 1.5 mg/mL (load) | VF/VT, AF | ★★★★★ |
| 9 | Lidocaine | 8 mg/mL | VT/VF (backup) | ★★★★ |
| 10 | Adenosine | Undiluted 3 mg/mL | PSVT | ★★★★ |
| 11 | Magnesium Sulfate | 40 mg/mL (load) | Eclampsia, TdP, asthma | ★★★★★ |
| 12 | Labetalol | 1 mg/mL | Hypertensive emergency | ★★★★ |
| 13 | Nicardipine | 0.1 mg/mL | Hypertensive crisis, SAH | ★★★★ |
| 14 | Sodium Nitroprusside | 0.2 mg/mL | Malignant HTN, aortic dissection | ★★★★ |
| 15 | Nitroglycerin | 0.1–0.2 mg/mL | ACS, acute pulmonary edema | ★★★★★ |
| 16 | Hydralazine | 0.2 mg/mL | Eclampsia | ★★★ |
| 17 | Propofol | 10 mg/mL (undiluted) | ICU sedation | ★★★★★ |
| 18 | Midazolam | 0.5 mg/mL | Sedation, status epilepticus | ★★★★ |
| 19 | Dexmedetomidine | 4 mcg/mL | Cooperative ICU sedation | ★★★★ |
| 20 | Ketamine | 1 mg/mL | RSI, asthma, analgesia | ★★★★ |
| 21 | Morphine | 1 mg/mL | Pain, acute pulmonary edema | ★★★★ |
| 22 | Fentanyl | 5–10 mcg/mL | ICU analgesia (preferred) | ★★★★★ |
| 23 | Heparin (UFH) | 100 units/mL | DVT/PE, ACS, ECMO | ★★★★★ |
| 24 | Alteplase (tPA) | 1 mg/mL | Ischemic stroke, massive PE | ★★★★★ |
| 25 | Regular Insulin | 1 unit/mL | DKA, hyperglycemia, hyperkalemia | ★★★★★ |
| 26 | KCl | 0.4 mEq/mL | Hypokalemia, DKA | ★★★★ |
| 27 | Sodium Bicarbonate | 1 mEq/mL (diluted) | TCA OD, metabolic acidosis | ★★★★ |
| 28 | Calcium Gluconate | 100 mg/mL | Hyperkalemia, hypocalcemia | ★★★★★ |
| 29 | Furosemide | 1 mg/mL | Acute pulmonary edema, fluid overload | ★★★★★ |
| 30 | Naloxone | 0.004 mg/mL (infusion) | Opioid overdose | ★★★★★ |
Prescribing safety notes:
- Always verify dilutions against your institution's pharmacy formulary and drug infusion charts.
- Medications marked with (use glass bottle) (nitroglycerin) or (protect from light) (nitroprusside) require special handling.
- Calcium and bicarbonate must never be mixed in the same line (CaCO₃ precipitate).
- Propofol must use a dedicated line; vials discarded every 12 h to prevent lipid-based infection.
- Sources: Harrison's Principles of Internal Medicine 22E; Goldman-Cecil Medicine; Rosen's Emergency Medicine; established ACLS/Surviving Sepsis/ICU pharmacology guidelines.
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