Epinephrine: Difference between revisions
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==Concentration== | ''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. | |||
== | ===[[Vasopressors|Pressor drip]]=== | ||
*0.1-1 mcg/kg/min | |||
==Pediatric Dosing== | |||
''See [[critical care quick reference]] for drug doses by weight.'' | |||
0.3-0. | ===[[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== | |||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | |||
*[[Lactation risk categories|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)<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 | |||
*Excretion: Renal | |||
*Mechanism of action: potent α and β agonist that increases cardiac output and peripheral vascular resistance | |||
==Mechanism of Action== | |||
===Primary Receptor=== | |||
*β<sub>1</sub> | |||
*α<sub>1</sub> | |||
*β<sub>2</sub> | |||
== | ===Relative Effects=== | ||
*↑↑↑HR | |||
*↑↑↑SV | |||
*↑↑↑SVR | |||
*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== | |||
*↑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 <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== | |||
*[[Digital EpiPen Injection]] | |||
*[[Critical care quick reference]] | |||
==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: | [[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