You can do 4mg/4cc (1:1) of norepinephrine in 1 liter of D5W. You can do 4mg or 8 mg to 250 ml of D5W or D5NS but not NS by itself. Ideally it should be given centrally; but I am thinking that was not feasible in your setting. At the least, give it through a big bore catheter, and if the patient can tolerate higher fluid load—large volume of fluid at a lower concentration of 1:1, a more dilute concentration can be used. But in depends on the patient cardiac, renal, and pulmonary function. It is best to correct blood vol. depletion or dehydration first. Of course, there again, central line placement and CVP monitoring can be helpful with that—even more ideal is PA catheter so that you can get a picture of cardiac indices, including SVRI—afterload issue. It’s MOA is alpha- and beta1-adrenergic receptors; so depending on the pt’s hemodynamics, this can be an issue, and you might not need to go to or use other gtts with it that might be more effective than maxing the heck out of it on the patient. And there can be a number of contraindications for its use. It’s also best to have an art line with it; b/c you should be monitoring BP no less than q 1-2 minutes if on it for severe refractory hypotension.
Again, you might have to be more judicious with that depending upon patient heart, pulmonary, and renal function. Epi and other gents may end up being more desirable before and effective—again together with norepi or without. Depends. Since I have recovered so many direct post-op patients, I tend to like to use some colloids whenever possible and helpful. I’ve also had my share of septic patients. Crystalloids can be quite a temporary fix but can lead to greater likelihood of failure—but then again, so can indiscriminate use of colloids.
Bottom line, the patient IMHO should have been moved out of there way earlier. You were right. You guys were not equipped to deal w/ the situation. Perhaps she would not have need norepinephrine at all if she were moved out earlier. There are other agents that may have been potentially more helpful to her—again, it depends on the specifics.
Its available in 5 mL vials (4 mL fill, 4 mg/4 mL) in boxes of 10. You should protect it from light and avoid mixing it with Fe salts or oxidizing or alkali agents.
For adults usually start at .5 to 1.0 mcg/min and depending on the level of shock, you can go to 30 mcg/min. I have, however, seen and given doses for end of the line cases that were > than 3Xs the later stated max dose in adults. But when severe enough, the truest max dose can be what is going to bring about the most decent pressure and ideally other more balanced hemodynamics indices. And a swan or pa cath could help with consideration of sepsis; since there are other agents, like vasopressin that may be more helpful. Sometimes you need to consider adding neo. That’s why I love hemodyamic monitoring and obtaining cardiac indices; b/c you can tweak and change the meds and monitor and change up so much better with the immediate cardiac indices information. This is one thing I miss in much of the critical care peds I do at times. But then again, their anatomy is so off, such pa monitoring wouldn’t be as helpful and the benefits don’t seem to outweigh the risks for them.
For kids it is 0.1 to 0.2 mcg/kg/min for acute refractory hypotension, starting at 0.05 to 0.1 mcg/kg/min and a max of 2 mcg/kg/min.
There are also extravasation necrosis precautions for peripheral usage.

I’m beat. Check back later.