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• W4230582588 abstract "Q Is it appropriate to adjust body surface area (BSA) and intravenously administered vasoactive medication dosage against daily weight changes in the intensive care unit (ICU)? Because of these significant changes, is admission weight acceptable? Is there such a thing as “dry weight”? If so, how is it defined and measured?A Nancy Faulkner, RPh, BS, replies:BSA is not an appropriate parameter by which to calculate or modify inotropic and vasopressor drug infusion doses in the ICU. BSA is not a kinetic variable; it remains nearly constant regardless of changes in patient weight. Weight is a good kinetic variable for predicting drug concentration, dose, and therapeutic response. It better reflects changes in volume of distribution of the “size of the tank” into which drugs are distributed. Drug doses for the inotropic vasopressor agents, which have wide therapeutic ranges and short durations of action, should be calculated on body weight. BSA is generally reserved for dosing agents with narrow therapeutic indices, such as oncologic drugs.The significant question becomes whether to respond to changes in patient body weight when calculating doses. The controversy is an issue only for initial dosing. The drugs under consideration—dobutamine, dopamine, isoproterenol, phenylephrine, epinephrine and norepinephrine—are all short-acting medications that are titrated to achieve a desired pharmacologic response. Changes in weight because of fluid overload, dehydration, or organ system (cardiac, renal, pulmonary, hepatic) function may result in changes in volume of distribution of drugs accompanied by changes in clinical response. The infusion rate is adjusted according to standard guidelines, or nomograms, until the appropriate response is reestablished. When considering the initial rate of infusion for these compounds, determine the dosing weight by using the following considerations:batchmode documentclass[fleqn,10pt,legalpaper]{article} usepackage{amssymb} usepackage{amsfonts} usepackage{amsmath} pagestyle{empty} begin{document} [Dosing weight=IBW [(ABW-IBW) {times} 0.4]] end{document}A practical method is simply to split the difference between ABW and IBW. Patients who can be identified as having abnormal fluid weight on admission to the ICU should probably be dosed on actual body weight, because the volume of distribution is larger than normal at this point. Vasopressors will distribute into the fluid compartments and initial doses could be too low unless one accounts for this possibility.“Dry weight” is a parameter used in hemodialysis, where the maximum amount of weight (fluid) that can be removed is measured by blood pressure response. The lowest weight achieved before the patient becomes hypotensive is considered the dry weight. It is not of practical utility for drug dosing.A reference list supporting the contentions of this article is not available due to the paucity of research defining the “best” dosing weight for intravenous vasoactive drugs. The research question is not compelling because the safety and efficacy profiles of these compounds do not demand dosing precision. Practitioners empirically support the various pharmacokinetic and pharmacologic-based approaches described here." @default.
• W4230582588 created "2022-05-11" @default.
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• W4230582588 date "2005-12-01" @default.
• W4230582588 modified "2023-10-01" @default.
• W4230582588 title "Ask the Experts" @default.
• W4230582588 doi "https://doi.org/10.4037/ccn2005.25.6.52" @default.
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