A 5-year-old child with meningococcal septicemia has BP 65/40 mmHg, HR 160/min, prolonged capillary refill of 5 seconds, and altered consciousness. Following initial fluid resuscitation, which vasopressor is recommended as first-line for fluid-refractory septic shock in children?
- A Epinephrine
- B Norepinephrine ✓
- C Dopamine
- D Vasopressin
Correct answer: B. Norepinephrine
Explanation
Updated Surviving Sepsis Campaign guidelines (2020) recommend norepinephrine as the first-line vasopressor for pediatric septic shock, particularly for warm shock with vasodilation. This represents a change from earlier guidelines that favored dopamine. Norepinephrine provides predominantly alpha-1 adrenergic vasoconstriction with less tachycardia. Epinephrine is used as second-line or for cold shock with poor cardiac output. Dopamine is an alternative when norepinephrine is unavailable.
Reference: Ghai Essential Pediatrics, 10th ed.
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