Epinephrine

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

Contraindications

  • Allergy to class/drug

Adverse Reactions

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

See Also

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