Epinephrine: Difference between revisions
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===[[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 beta-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=== | ===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. | *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== | ||
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==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Onset of action: 1-2 minutes (IV), 8-10 minutes (IM) | ||
*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) | |||
*Metabolism: Hepatic | *Metabolism: Hepatic | ||
*Excretion: Renal | *Excretion: Renal | ||
*Mechanism of action: potent α and β agonist that increases cardiac output and peripheral vascular resistance | *Mechanism of action: potent α and β agonist that increases cardiac output and peripheral vascular resistance | ||
==Mechanism of Action== | ==Mechanism of Action== | ||
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*β<sub>1</sub> | *β<sub>1</sub> | ||
*α<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 ("inotropic" epinephrine) | |||
*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== | ==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> | *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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[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:Critical Care]] |
Latest 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
- 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
- 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
- ↑ PALS
- ↑ 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/
- ↑ https://www.ncbi.nlm.nih.gov/pubmed/18654759