How is dopamine used when presented as 200 mg in 5 ml rather than 200 mg in 250 ml?
Good Friday Morning:
Within the equipment standards, it lists two options for Dopamine. Dopamine HCL Solution, 200mg/250mL or Dopamine HCL injection 200mg/5mL. I am guessing that is to allow paramedics to mix their own solution (I could be completely incorrect, but I don’t think we can give it in bolus aliquots…😉).
If this is the case, what is the expectations for mixing. In the prepared solutions, dopamine is provided in a D5 solution, but there is no requirement within the equipment standards to carry D5.
Is it permissible to mix it in NaCl, which we are required to carry?
The provincial equipment standards provide two options for carrying dopamine: either as a 200 mg in 250 ml solution, or as a 200 mg in 5 ml injection. This does not change how dopamine is to be administered. Dopamine it is only to be administered through IV infusion. Dopamine presented as 200 mg in 5 ml (40 mg/ml) is a concentrate and has to be diluted in normal saline (NS) or 5% dextrose in water (D5W). Using the concentrated preparation (200 mg in 5 ml) without dilution is very dangerous - there is no scenario where a bolus of dopamine should be administered.
Any service carrying dopamine concentrate should provide 250 ml NS or D5W bags, have highly visible warning labels on the dopamine, and, store the dopamine in a separate pouch to other medications. Preparation is simply to add the 5 ml dopamine (200 mg) to the 250 ml NS or D5W, then deliver as with a prepared solution for infusion.
It is unlikely that you will come across dopamine concentrate as this presentation is not currently marketed in Canada. If you do come across dopamine 200 mg in 5 ml please alert the base hospital.
Patient Care Standards
The ROSC Medical Directive (ALS PCS v5.1, p99) provides a dosing chart for an 800 mcg/ml dopamine infusion. 800 mcg/ml is 200 mg (of dopamine) in 250 ml.
EHRAB, 2023. Provincial Equipment Standards for Ontario Ambulance Service, v3.7, 01 Feb 2023. Ontario MOH.
Baxter Corporation, 2016. Product Monograph: Dopamine Hydrochloride 800, 1600, and 3200 µg/mL and 5% Dextrose in VIAFLEX Plastic Container.
Health Canada. Drug Product Database, Search Active Ingredient: Dopamine. Accessed 06 March 2023.
Lexicomp. Dopamine: Drug information. Accessed 06 Mar 2023