An 8-month-old infant (8 kg) with septic shock unresponsive to two 10 mL/kg boluses of normal saline remains hypotensive. Which vasoactive agent is first-line in fluid-refractory septic shock in children?
- A Vasopressin
- B Norepinephrine
- C Dopamine ✓
- D Epinephrine
Correct answer: C. Dopamine
Explanation
Dopamine is the traditional first-line vasoactive agent for fluid-refractory septic shock in children per PALS and Surviving Sepsis Campaign pediatric guidelines. At low doses (2–5 mcg/kg/min) it has dopaminergic effects, at moderate doses (5–10 mcg/kg/min) it has beta-adrenergic effects, and at high doses (>10 mcg/kg/min) it has alpha effects. Norepinephrine may be preferred in warm/vasodilatory shock, and epinephrine in cold shock, but dopamine remains the default pediatric first-line agent.
Reference: Ghai Essential Pediatrics, 10th ed.
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