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The Surviving Sepsis Campaign guidelines recommend the very early management of the sepsis focusing on the hour-1 bundle. This includes use of Vasopressin 0.03 units/minute as add-on to norepinephrine (NE) with intent of either raising the mean arterial pressure or decreasing the norepinephrine dosage (i.e. de-catecholaminization). [13]
Norepinephrine, also known as noradrenaline and sold under the brand name Levophed among others, is a medication used to treat people with very low blood pressure. [2] It is the typical medication used in sepsis if low blood pressure does not improve following intravenous fluids . [ 3 ]
Patients with NOH have depleted levels of norepinephrine which leads to decreased blood pressure or hypotension upon orthostatic challenge. [14] Droxidopa works by increasing the levels of norepinephrine in the peripheral nervous system (PNS), thus enabling the body to maintain blood flow upon and while standing. [14]
Metaraminol is a norepinephrine releasing agent and at high doses a α 1-adrenergic receptor agonist with some β-adrenergic effect. [6] [7] [8] It is a substituted amphetamine and is closely related to phenylpropanolamine, ephedrine, and oxilofrine. [4] [5] Metaraminol was first described and introduced for medical use by 1955. [9] [10]
Norepinephrine, epinephrine, dopamine, and phenylephrine contribute mainly through their vasopressor (vasoconstrictive) functions to constrict blood vessels to correct hypotension. Whereas, dobutamine , milrinone , enoximone , and levosimendan , act to restore the heart’s pumping function. [ 80 ]
The dose should be increased after a minimum of 3 days up to approximately 1.2 mg/kg daily (target dose) as a single or two divided doses (in the morning and late afternoon). For children older than 6 years old, over 70 kg, acute treatment should be started with 40 mg/day orally and increased up to 80 mg/day after a minimum of 3 days.
Norepinephrine Epinephrine. A norepinephrine reuptake inhibitor (NRI, NERI) or noradrenaline reuptake inhibitor or adrenergic reuptake inhibitor (ARI), is a type of drug that acts as a reuptake inhibitor for the neurotransmitters norepinephrine (noradrenaline) and epinephrine (adrenaline) by blocking the action of the norepinephrine transporter (NET).
Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones.The adrenal glands—also referred to as the adrenal cortex—normally secrete glucocorticoids (primarily cortisol), mineralocorticoids (primarily aldosterone), and androgens.