Answer is D (Norepinephrine) The patient in question is presenting with features of septic shock. Dopamine is the initial recommended vasopressor agent to maintain blood pressure but is not provided amongst the options. Patients who remain hypotensive despite dopamine should he adminstered norepinephrine and hence norepinephrine is the single best answer of choice here. Harrison 14th / 221 Treatment of septic shock Iffluid therapy alone fails to restore adequate aerial pressure and organ perfusion , therapy with vaso pressor agent should be intitiated. For the persistantly hypotensive patient dopamine frequently raises aerial pressure and maintains or enhances blood flow to the renal and splanchnic circulation. Patients who remain hypotensive despite dopamine require nor epinephrine, a more potent vasopressor. Once hypotension, has been corrected to optimize oxygen delivery to tissues, raising a low cardiac index with dobutamine can be useful - Harrisons 16th / 605 : Treatment of septic shock In the presence of sepsis, augmentation of cardiac output may require inotropic suppo with dopamine, nore pinephrine or vaso pressin in the presence of hypotension or with dobutamine if aerial pressure is normal