Cold shock: Start with Dopamine up to 10 mcg/kg/min or
Epinephrine 0.05 to 0.3 mcg/kg/min
Warm shock: Norepinephrine 0.05 to 0.3 mcg/kg/min*Epinephrine and higher doses of dopamine should be given
through central access only.45 - 60 minutes: If catecholamine resistant shock persists, adjuncts to
therapy and monitoring need to be considered. These include the
following:
- Treat absolute or relative adrenal insufficiency with
Hydrocortisone at a dose of 50 mg/m^2 /24 hr. Consideration of
adrenal insufficiency should be timely, as septic shock in
conjunction with absolute adrenal insufficiency carries a high
risk of mortality, occurring within 8 hours of presentation. Close
to 25% of with children sepsis may have absolute adrenal
insufficiency. A baseline cortisol level may be obtained, but