title: The effects of dopamine and adrenaline infusions on acid-base balance and systemic haemodynamics in severe infection.
abstract: BACKGROUND
  Adrenaline is used increasingly in the management of septic shock, but its efficacy and safety are uncertain.
  
  
  METHODS
  In an open, randomised, crossover study we compared the effects of stepped doses of adrenaline 0.1 to 0.5 microgram/kg per min and dopamine 2.5 to 10 micrograms/kg per min on the haemodynamic and acid-base status of 23 patients critically ill with severe sepsis (n = 10) or severe malaria (n = 13).
  
  
  RESULTS
  All patients completed the dopamine study whereas in 16 (84%) patients the adrenaline infusion had to be terminated before reaching, or during, the maximum dose because of lactic acidosis (p < 0.0002). Adrenaline was associated with a mean (95% CI) increase in plasma lactate of 3.2 (2.6 to 3.8) mmol/L, and mean falls in arterial pH of 0.052 (0.035-0.068) pH units and base excess of 3.8 (2.8-4.7) mmol/L. The geometric mean (95% CI) lactate increment per unit adrenaline dose was 8.2 (5.8-10.5) mmol/L per microgram/kg per min. In contrast dopamine was associated with a fall in lactate of 1.0 (0.4-1.5) mmol/L, a rise in base excess of 1.4 (0.7 to 2.0) mmol/L (p < 0.0001 in each case), and no effect on arterial pH. Both drugs induced significant increases in cardiac index and oxygen delivery with smaller increases in oxygen consumption and falls in systemic vascular resistance which were similar in severe malaria and severe sepsis (p > 0.1 in each case) [corrected].
  
  
  CONCLUSIONS
  Infusion of inotropic doses of adrenaline in severe infections causes lactic acidosis.
authors.affiliation: Centre for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Viet Nam.
authors.forename: N P
authors.initials: NP
authors.lastname: Day
authors.forename: N H
authors.initials: NH
authors.lastname: Phu
authors.forename: D P
authors.initials: DP
authors.lastname: Bethell
authors.forename: N T
authors.initials: NT
authors.lastname: Mai
authors.forename: T T
authors.initials: TT
authors.lastname: Chau
authors.forename: T T
authors.initials: TT
authors.lastname: Hien
authors.forename: N J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000140:Acidosis, Lactic / Q000139:chemically induced; D000293:Adolescent; D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D004298:Dopamine / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000188:drug therapy*
chemical_list: D004298:Dopamine; D004837:Epinephrine