Epinephrine: Difference between revisions
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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 patient on | *Consider glucagon 1-5mg IV if patient on beta-blockers and not responding to epi | ||
===[[Anaphylactic shock]]=== | ===[[Anaphylactic shock]]=== | ||
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===Quick Epi Drip=== | ===Quick Epi Drip=== | ||
*Take your code-cart | *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.'' | ||
== | ===[[Pediatric pulseless arrest|Pulseless Arrest]]<ref>PALS</ref>=== | ||
=== | *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 (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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==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: | ||
*Metabolism: | *Metabolism: Hepatic | ||
*Excretion: | *Excretion: Renal | ||
*Mechanism of Action | *Mechanism of action: potent α and β agonist that increases cardiac output and peripheral vascular resistance | ||
==Mechanism of Action== | |||
===Primary Receptor=== | ===Primary Receptor=== | ||
* | *β<sub>1</sub> | ||
* | *α<sub>1</sub> | ||
* | *β<sub>2</sub> | ||
===Relative Effects=== | ===Relative Effects=== | ||
*↑↑↑HR | *↑↑↑HR | ||
*↑↑↑SV | *↑↑↑SV | ||
*↑↑↑SVR | *↑↑↑SVR | ||
*Bronchodilation ( | *Bronchodilation (β<sub>2</sub>) | ||
===Dose-dependent effects=== | |||
*1-10 mcg/min - increase HR and SV | |||
*10-20 mcg/min - increase SVR | |||
==Notes== | ==Notes== | ||
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*Use with caution in patients 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 pressors 2/2 increased number of adverse events that include tachydysrhythmias and lactate production | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<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 | |||
[[Category:Pharmacology]] | [[Category:Pharmacology]] |
Revision as of 16:10, 13 September 2018
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
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
- Pregnancy Rating: C
- Lactation risk: Infant risk cannot be ruled out
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Contraindications
- Allergy to class/drug
Adverse Reactions
- Tachyarrhythmias
- Myocardial ischemia
- Increased serum lactate
- Splanchnic ischemia
- Digital EpiPen injection
Pharmacology
- Half-life:
- 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
- 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 [2]
- second- line agent in sepsis that should be considered after shock is refractory to other pressors 2/2 increased number of adverse events that include tachydysrhythmias and lactate production