Epinephrine: Difference between revisions

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''See [[critical care quick reference]] for drug doses by weight.''
==General==
==General==
*Type: [[Vasopressors]]
*Type: [[Vasopressors]]
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**Amount of solution in mL used to dilute 1,000mg of epinephrine
**Amount of solution in mL used to dilute 1,000mg of epinephrine
**eg 1:10,000 = 1,000mg/10,000mL = 0.1mg/mL
**eg 1:10,000 = 1,000mg/10,000mL = 0.1mg/mL
*Common Trade Names: Adrenaline
*Common Trade Names: Adrenaline, EpiPen (IM autoinjector)


==Adult Dosing==
==Adult Dosing==
===[[Anaphylaxis]]===
===[[Anaphylaxis]]===
0.3-0.5mg of 1:1,000 IM
0.3-0.5mg of 1:1,000 IM
*Consider glucagon 1-5mg IV if pt on B-blockers and not responding to epi
*Consider [[glucagon]] 1-5mg IV if patient on beta-blockers and not responding to epi


===[[Anaphylactic shock]]===
===[[Anaphylactic shock]]===
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===[[Cardiac Arrest]]===
===[[Cardiac Arrest]]===
1mg of 1:10,000 IVP
1mg of 1:10,000 IVP (10cc's total or 1 "amp")
 
===Quick Epi Drip===
*Take your code-cart epinephrine (it does not matter if It is 1:1,000 or 1:10,000) and inject 1mg into a liter bag of NS. Final concentration is 1mcg/ml. Run at 1cc/min and titrate to effect.
 
===[[Vasopressors|Pressor drip]]===
*0.1-1 mcg/kg/min


==Pediatric Dosing==
==Pediatric Dosing==
''See [[critical care quick reference]] for drug doses by weight.''
''See [[critical care quick reference]] for drug doses by weight.''


==Pressors==
===[[Pediatric pulseless arrest|Pulseless Arrest]]<ref>PALS</ref>===
===Dosing===
*0.01 mg/kg (1:10,000 solution) IV/IO q3-5 min
*Dose-dependent effects:
*Max: 1mg/dose
*1-10 mcg/min - increase HR and SV
 
*10-20 mcg/min - increase SVR
===[[Anaphylaxis]]===
===Rate of Titration===
*0.01 mg/kg (1:1,000 solution) SC/IM x 1
*Q2-5 min
**Max: 0.3 mg/dose in pre-pubertal patients; 0.5 mg/dose in teenage patients
**May repeat dose q5-15 min x 2
 
===Severe [[Asthma (peds)|Asthma]]===
*0.01 mg/kg (1:1,000 solution) SC/IM x 1
**Max: 0.3 mg/dose in pre-pubertal patients; 0.5 mg/dose in teenage patients
**May repeat dose q5-15 min x 2
 
===[[Vasopressors|Pressor drip]]===
*0.1-1 mcg/kg/min


==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*Lactation:
*[[Lactation risk categories|Lactation risk]]: Infant risk cannot be ruled out
*Renal Dosing
*Renal Dosing
**Adult
**Adult
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==Adverse Reactions==
==Adverse Reactions==
*Tachyarrhythmias
*Tachyarrhythmias
*Myocardial ischemia
*[[Myocardial ischemia]]
*↑Serum lactate
*Increased serum lactate
*Splanchnic ischemia
*Splanchnic ischemia
*[[Digital EpiPen injection]]


==Pharmacology==
==Pharmacology==
*Half-life:  
*Onset of action: 1-2 minutes (IV), 8-10 minutes (IM)
*Metabolism:  
*Half-life: < 5 minutes (IV)<ref>Dalal R, Grujic D. Epinephrine. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482160/</ref>, 45 minutes (IM)
*Excretion:  
*Metabolism: Hepatic
*Mechanism of Action:
*Excretion: Renal
*Mechanism of action: potent α and β agonist that increases cardiac output and peripheral vascular resistance
 
==Mechanism of Action==
===Primary Receptor===
===Primary Receptor===
*β1
*β<sub>1</sub>
*α1
*α<sub>1</sub>
*β2
*β<sub>2</sub>
 
===Relative Effects===
===Relative Effects===
*↑↑↑HR  
*↑↑↑HR  
*↑↑↑SV
*↑↑↑SV
*↑↑↑SVR  
*↑↑↑SVR  
*Bronchodilation (β2)
*Bronchodilation (β<sub>2</sub>)
 
===Dose-dependent effects===
*1-10 mcg/min - increase HR and SV ("inotropic" epinephrine)
*10-20 mcg/min - increase SVR


==Notes==
==Notes==
*↑lactate occurs primarily from ↑glycolysis/glycogenolysis within skeletal muscles not tissue hypoperfusion
*↑lactate occurs primarily from ↑glycolysis/glycogenolysis within skeletal muscles not tissue hypoperfusion
*Use with caution in pts with CAD
*Use with caution in patients with CAD
**However clinical trials have not demonstrated worsened outcomes
**However clinical trials have not demonstrated worsened outcomes
==Indications==
*Epi versus norepi in patients with shock found that elevated levels of lactic acidosis or tachycardia in 13% of epi patients causes <ref> https://www.ncbi.nlm.nih.gov/pubmed/18654759 </ref>
*Second-line agent in sepsis that should be considered after shock is refractory to other [[vasopressors]] 2/2 increased number of adverse events that include tachydysrhythmias and lactate production


==See Also==
==See Also==
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*[[Critical care quick reference]]
*[[Critical care quick reference]]


==Sources==
==References==
<references/>
http://www.atsjournals.org/doi/abs/10.1164/rccm.201006-0972CI?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#readcube-epdf


<references/>
[[Category:Pharmacology]]
[[Category:Drugs]]
[[Category:Critical Care]]

Revision as of 19:40, 14 August 2023

See critical care quick reference for drug doses by weight.

General

  • Type: Vasopressors
  • Dosage Forms:
  • Concentration
    • Amount of solution in mL used to dilute 1,000mg of epinephrine
    • eg 1:10,000 = 1,000mg/10,000mL = 0.1mg/mL
  • Common Trade Names: Adrenaline, EpiPen (IM autoinjector)

Adult Dosing

Anaphylaxis

0.3-0.5mg of 1:1,000 IM

  • Consider glucagon 1-5mg IV if patient on beta-blockers and not responding to epi

Anaphylactic shock

0.1mg of 1:10,000 slow IV during 5 min, can start infusion of 1-4 mcg/min

Cardiac Arrest

1mg of 1:10,000 IVP (10cc's total or 1 "amp")

Quick Epi Drip

  • Take your code-cart epinephrine (it does not matter if It is 1:1,000 or 1:10,000) and inject 1mg into a liter bag of NS. Final concentration is 1mcg/ml. Run at 1cc/min and titrate to effect.

Pressor drip

  • 0.1-1 mcg/kg/min

Pediatric Dosing

See critical care quick reference for drug doses by weight.

Pulseless Arrest[1]

  • 0.01 mg/kg (1:10,000 solution) IV/IO q3-5 min
  • Max: 1mg/dose

Anaphylaxis

  • 0.01 mg/kg (1:1,000 solution) SC/IM x 1
    • Max: 0.3 mg/dose in pre-pubertal patients; 0.5 mg/dose in teenage patients
    • May repeat dose q5-15 min x 2

Severe Asthma

  • 0.01 mg/kg (1:1,000 solution) SC/IM x 1
    • Max: 0.3 mg/dose in pre-pubertal patients; 0.5 mg/dose in teenage patients
    • May repeat dose q5-15 min x 2

Pressor drip

  • 0.1-1 mcg/kg/min

Special Populations

Contraindications

  • Allergy to class/drug

Adverse Reactions

Pharmacology

  • Onset of action: 1-2 minutes (IV), 8-10 minutes (IM)
  • Half-life: < 5 minutes (IV)[2], 45 minutes (IM)
  • Metabolism: Hepatic
  • Excretion: Renal
  • Mechanism of action: potent α and β agonist that increases cardiac output and peripheral vascular resistance

Mechanism of Action

Primary Receptor

  • β1
  • α1
  • β2

Relative Effects

  • ↑↑↑HR
  • ↑↑↑SV
  • ↑↑↑SVR
  • Bronchodilation (β2)

Dose-dependent effects

  • 1-10 mcg/min - increase HR and SV ("inotropic" epinephrine)
  • 10-20 mcg/min - increase SVR

Notes

  • ↑lactate occurs primarily from ↑glycolysis/glycogenolysis within skeletal muscles not tissue hypoperfusion
  • Use with caution in patients with CAD
    • However clinical trials have not demonstrated worsened outcomes

Indications

  • Epi versus norepi in patients with shock found that elevated levels of lactic acidosis or tachycardia in 13% of epi patients causes [3]
  • Second-line agent in sepsis that should be considered after shock is refractory to other vasopressors 2/2 increased number of adverse events that include tachydysrhythmias and lactate production

See Also

References

  1. ↑ PALS
  2. ↑ Dalal R, Grujic D. Epinephrine. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482160/
  3. ↑ https://www.ncbi.nlm.nih.gov/pubmed/18654759

http://www.atsjournals.org/doi/abs/10.1164/rccm.201006-0972CI?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#readcube-epdf

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