Overview of intravenous inotrope infusions

The choice of inotrope1 depends on the patient’s clinical condition and the available resources. Doses of inotropes higher than standard doses are sometimes required for the management of poisonings.

Follow local hospital protocols if available. If local hospital protocols are not available, the advice in this appendix, which is the consensus of the Toxicology and Toxinology Expert Group, can be used for preparation and administration of the following intravenous inotrope infusions:

For further information on the types of inotropic support commonly used in poisonings, and detailed instructions for high-dose insulin euglycaemia therapy (HIET), see Inotropic support: first-line therapy and High-dose insulin euglycaemia therapy (HIET).

It is preferable to administer intravenous inotropes via a central venous catheter, but a large-bore peripheral vein may be used temporarily before obtaining central venous access.

1 True inotropic drugs specifically increase cardiac contractility (eg adrenaline [epinephrine]); however, the term ‘inotropic support’ is commonly also used to refer to vasopressor drugs (eg argipressin [vasopressin], noradrenaline [norepinephrine]) and chronotropic drugs (eg isoprenaline). Throughout this guideline, the term ‘inotropic support’ refers to adrenaline, argipressin (vasopressin), high-dose insulin euglycaemia therapy (HIET), isoprenaline and noradrenaline.Return