How to use this tool: Enter the drug, the patient weight and the target rate. All calculations assume the drug is made up to 50 mL, or the stated standard volume, in the compatible solvent named, and delivered by syringe pump.
1. Patient Parameters
2. Select Infusion
Indian Clinical Context & Points to Note
Critical care dosing in the subcontinent requires strict attention to variable pharmaceutical packaging and supply chain realities:
Noradrenaline Ampoules: Highly variable. Check if the ampoule contains 2 mg in 2 ml or 4 mg in 2 ml. The protocol requires a total of 4 mg (Single) or 8 mg (Double) in the syringe.
Amiodarone Diluent: Must strictly be diluted in 5% Dextrose ONLY. Saline causes immediate precipitation. Additionally, PVC bags absorb the drug; use glass bottles or polyolefin bags if possible.
Vasopressin: Do not titrate like Noradrenaline. It acts on V1 receptors to restore vascular tone and is used at a fixed rate of 0.04 units/min.
1. Illness Scripts: Vasopressor Selection
Clinical State
First Line
Rationale
Septic Shock
Noradrenaline
Potent alpha-1 agonism restores systemic vascular resistance (SVR) without the extreme tachyarrhythmia risk of Dopamine. Add Vasopressin if > 0.25-0.5 microgram/kg/min required.
Cardiogenic Shock
Noradrenaline + Dobutamine
Noradrenaline maintains MAP for coronary perfusion; Dobutamine provides inotropy. Dopamine is restricted due to higher mortality in cardiogenic shock.
Anaphylactic Shock
Adrenaline
Mixed alpha and beta agonism. Relieves bronchospasm, reduces mast cell degranulation, and supports cardiac output and SVR simultaneously.
The Surviving Sepsis Campaign published its 2026 guidelines in March 2026, replacing the 2021 edition this module was built against. 129 statements, 46 of them new. Four points change how the infusions calculated here should be titrated:
MAP target 65 mmHg initially, and 60 to 65 mmHg in patients aged 65 and over. This is the practical change. Targeting higher pressures across the board in vasodilatory shock is associated with increased mortality, so the older patient is titrated to a lower, not a higher, number.
Peripheral initiation of vasopressors is suggested rather than waiting on central access. A delay in starting noradrenaline is itself a harm.
Fluids: at least 30 mL/kg crystalloid within the first three hours in sepsis-induced hypoperfusion or septic shock, with frequent reassessment. The reassessment is the point; the 30 mL/kg is a starting position, not a target to be met regardless of response.
Active fluid removal is suggested after the acute resuscitation phase, with diuretics first and ultrafiltration if diuretics are insufficient. Judged on cardiorespiratory function, vasopressor dose, oedema, weight and cumulative balance.
Vasopressor selection in the table above is unchanged by the 2026 edition. Noradrenaline remains first line in septic shock.
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med / Intensive Care Med. 2026. [Current edition; supersedes 2021. 129 statements, 46 new.]
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med. 2021;47(11):1181-1247. [Superseded March 2026]
Indian Society of Critical Care Medicine (ISCCM). Standard Treatment Guidelines for Hemodynamic Support in Sepsis.
Tariq SM, et al. Vasopressor and Inotrope Use in Indian ICUs: A Practice Pattern Survey. Indian J Crit Care Med.
Advanced Cardiac Life Support (ACLS) Guidelines, American Heart Association (AHA) Updates.
How to Cite This Tool
AMA Style:
Umakanth S. ICU Infusion & Inotrope Dosing Calculator. MEDiscuss. Published 2026. Accessed .
Vancouver Style:
Umakanth S. ICU Infusion & Inotrope Dosing Calculator [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:
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