How to give injection dopamine 200mg/5ml in a 50 year old patient with no recordable bp and pulse? Give exact measure to administer dopamine?
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ACLS management patient no pulse no blood pressure pulseless electrical activity protocol
Critical safety point first
A patient with no recordable pulse is in cardiac arrest (pulseless electrical activity or asystole), not a "give a vasopressor drip" situation. Dopamine infusion is not part of the pulseless-arrest algorithm. The correct immediate sequence is:
- Call for help / crash cart, start high-quality CPR (30:2 if not intubated) - Rosen's Emergency Medicine, Goldman-Cecil Medicine
- Attach monitor/defibrillator - if VF/VT, shock; if PEA/asystole, these are non-shockable
- Secure airway, get IV/IO access
- Epinephrine 1 mg IV/IO (1:10,000) every 3-5 minutes - this is the vasopressor used in cardiac arrest, not dopamine
- Search for and treat the reversible causes (H's and T's: hypovolemia, hypoxia, hydrogen ion/acidosis, hypo/hyperkalemia, hypothermia; tension pneumothorax, tamponade, toxins, thrombosis-coronary/pulmonary) - Tintinalli's Emergency Medicine; LITFL
Dopamine only becomes relevant after return of spontaneous circulation (ROSC), if the patient remains hypotensive with a perfusing rhythm/pulse, or in a shock state where a pulse and some blood pressure exist but are critically low. If your patient genuinely has no pulse, stop reading dosing charts and start CPR/call the resuscitation team - this is not something to solve by calculating a drip rate.
If this is post-ROSC or severe hypotensive shock (pulse present, BP unrecordable/very low) - dopamine dosing
Preparation of your ampoule (200 mg/5 mL = 40 mg/mL):
| Dilution | Final concentration |
|---|---|
| 200 mg (5 mL) in 500 mL D5W/NS | 400 mcg/mL |
| 200 mg (5 mL) in 250 mL D5W/NS | 800 mcg/mL |
Dopamine must be given via infusion pump into a large vein/central line (peripheral extravasation causes severe tissue necrosis) with continuous ECG and BP monitoring - never as a bolus.
Dose ranges (weight-based, titrate to effect):
- 1-5 mcg/kg/min - low/renal dose (rarely used now, not for pressor effect)
- 5-10 mcg/kg/min - inotropic (beta) effect, increases cardiac output
- 10-20 mcg/kg/min - vasopressor (alpha) effect, raises BP - this is the range typically used in refractory hypotension/shock
Exact rate calculation (using 400 mcg/mL dilution, i.e. 200 mg in 500 mL):
Rate (mL/hr) = (dose in mcg/kg/min x weight in kg x 60) / concentration in mcg/mL
For an average 50-year-old adult (assume ~70 kg - confirm actual weight before administering):
| Dose | Calculation | Infusion rate |
|---|---|---|
| 5 mcg/kg/min | (5x70x60)/400 | 5.25 mL/hr |
| 10 mcg/kg/min | (10x70x60)/400 | 10.5 mL/hr |
| 15 mcg/kg/min | (15x70x60)/400 | 15.75 mL/hr |
| 20 mcg/kg/min | (20x70x60)/400 | 21 mL/hr |
If using the more concentrated 800 mcg/mL dilution (200 mg in 250 mL), halve all the above rates.
Practical approach: Start at 5 mcg/kg/min, titrate up every few minutes based on BP response (target MAP ≥65 mmHg or systolic ≥90 mmHg), typically not exceeding 20 mcg/kg/min without escalating to a second agent (norepinephrine is now preferred first-line in most shock states - Brenner and Rector's The Kidney; Murray & Nadel's Respiratory Medicine).
This calculation is for reference only - actual weight, renal/cardiac status, and the underlying cause of the collapse must be confirmed by the treating physician before any infusion is started. I can't provide dosing that substitutes for a bedside clinical decision, especially given the pulseless detail in your question - please clarify if this patient truly has no pulse, since that changes the entire management pathway to CPR/ACLS rather than a dopamine drip.
Make a dopamine dosing calculator spreadsheet for different weights
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mkdir -p /tmp/workspace/dopamine-calculator && ls -la /tmp/workspace/
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