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.

Pediatric Dosing

See critical care quick reference for drug doses by weight.

Pressors

Dosing

• Dose-dependent effects:
• 1-10 mcg/min - increase HR and SV
• 10-20 mcg/min - increase SVR

Rate of Titration

• Q2-5 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

Primary Receptor

• β1
• α1
• β2

Relative Effects

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

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

See Also

• Digital EpiPen Injection
• Critical care quick reference

References

Authors

Ross Donaldson, Jeff Rogers, Claire, Genevieve Hasek, Daniel Ostermayer, Neil Young