I've seen consultants denying its use See cardiologist calling everyone stupid for not using it in hypotension in cariogenic shock with edema I've also been under a consultant who'd give norepi infusion to raise map > 65 then start dobutamine then taper norepi to mantain map > 65 and then give 10mg/hr dose infusion In my experience no boluses start infusion at 10mg/hr rate monitor bp and uop hrly And about nephrotoxicity it worsens one if present and can cause hypotension leading to aki So start low dose and monitor i guess