Difference between the measured and ordered dose of catecholamine infusions.
OBJECTIVE
To measure the actual concentrations of dopamine, dobutamine, and epinephrine in infusates prepared for patients, and to compare these concentrations with those of the dopamine HCl, dobutamine, and epinephrine HCl infusates that had been prescribed to evaluate drug preparation accuracy.


METHODS
Prospective, unblind study.


METHODS
Pediatric intensive care unit in a tertiary-care teaching hospital.


METHODS
All dopamine, dobutamine, and epinephrine infusions ordered for patients during the 2-month study period were eligible for inclusion in the study.


METHODS
Daily samples of dopamine, dobutamine, and epinephrine infusates that were prepared for 41 pediatric patients were obtained; the infusate catecholamine concentration was measured by HPLC and compared with the ordered concentration. The concentration than was multiplied by the rate of infusion to determine the catecholamine dose.


RESULTS
There were significant differences between the measured doses of dopamine, dobutamine, and epinephrine and the dopamine HCl, dobutamine, and epinephrine HCl doses (p = 0.0001, p = 0.039, and p = 0.0009, respectively) that had been ordered because of preparation inaccuracies. Failure to account for the HCl salt in the stock drug accounted for some, but not all, of the inaccuracy of the dopamine HCl and epinephrine HCl infusates. There was a wide interday variability in the measured catecholamine dosage in patients receiving the same dose for 3 days or more.


CONCLUSIONS
There are daily fluctuations in the preparation of dopamine, dobutamine, and epinephrine infusates that could alter the amount of drug actually delivered to critically ill patients and potentially contribute to their hemodynamic instability.
Allen
E M
EM
Division of Pediatric Critical Care, Primary Children's Medical Center, Salt Lake City, UT 84113, USA.
Van Boerum
D H
DH
Olsen
A F
AF
Dean
J M
JM
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid; D004280:Dobutamine / Q000008:administration & dosage* / Q000032:analysis; D004298:Dopamine / Q000008:administration & dosage* / Q000032:analysis; D004355:Drug Stability; D004837:Epinephrine / Q000008:administration & dosage* / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008508:Medication Errors; D011446:Prospective Studies
D004280:Dobutamine; D004298:Dopamine; D004837:Epinephrine