Basics of Vasopressors, Part 3: Vasopressin

Mon, 02/07/2022 - 5:00am
Author: 
Laura Di Taranti, MD
Editor: 
Alison Jaworski, MD

About vasopressin 

  • Mechanism of action: V1, V2 agonism. V1 is present on blood vessels and results in peripheral vasoconstriction. This results in an increase in preload, afterload, and SVR. V2 is located in the kidneys and promotes the retention of water; remember that vasopressin and ADH are synonyms! This increases plasma volume, which can increase blood pressure.  

  • Uses: as an adjunct to most other pressors (usually to help wean down norepinephrine). May be a good pressor for hepatorenal syndrome, as patients who received norepinephrine/vasopressin rather than just norepinephrine were less likely to require dialysis.  

  • Avoid: peripherally, as it can cause ischemia that has no antidote. Also avoid for hypoNa, as water retention at the level of the kidneys can worsen hypoNa. Vasopressin at lower doses than a pressor dose is actually used for hyperNa, specifically DI.

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Our 'obligatory' table of pressors, for comparison:

 

 

References:

  • Farkas, Josh. The Internet Book of Critical Care. Vasopressors. Accessed on December 7th, 2021. Available at https://emcrit.org/ibcc/pressors/.  

  • Farkas, Josh. The Internet Book of Critical Care Podcast 78 – Vasoactive Agents. Published on February 20th, 2020. Accessed on December 7th, 2021. Available at https://emcrit.org/pulmcrit/pressors/.  

  • Kim SM, Aikat S, Bailey A. Well recognised but still overlooked: norepinephrine extravasation. BMJ Case Reports 2012;2012:bcr2012006836:. doi: 10.1136/bcr-2012-006836. 

  • Khanna, A et al. Angiotensin II for the treatment of vasodilatory shock. NEJM 2017;377:419-430. doi: 10.1056/NEJMoa1704154. 

  • Manaker, Scott. Use of vasopressors and inotropes. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. (Accessed December 7th, 2021)  

  • Parekh M, Andreae M. EM Resident. The Crashing Patient with Critical Aortic Stenosis. Published October 3rd, 2017. Accessed on December 9th, 2021. Available at https://www.emra.org/emresident/article/the-crashing-patient-with-critical-aortic-stenosis/. 

  • Rezaie, Salim. Rebel EM. Peripheral Pressors: 6 Pearls Not to F*#k Up the Arm. Published on June 4th, 2020. Accessed on December 7th, 2021. Available at https://rebelem.com/peripheral-pressors-6-pearls-to-not-fk-up-the-arm/.  

  • Shields SH, Holland RM. Pharmacology of vasopressors and inotropes. In: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9th edition. New York, NY: McGraw-Hill Education; 2020: 133-137.