Dilution Epinephrine

EPINEPHRINE

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Usual Diluents

NS, D5W

Standard Dilutions [Amount of drug] [Infusion volume] [Infusion rate]

[1 to 5 mg] [250 ml] [Titrate]

Central line required for administration.

Stability / Miscellaneous

EXP: 1 DAY (RT).

Dosing:
Continuous infusion: 1 to 4 mcg/min.
Anaphylaxis (adult): 0.1 to 0.5 SC / IM (1:1000) repeat q10 to 15 minutes prn or give 0.1 to 0.25 mg IV (1:10,000) over 5-10min repeat q5 to 15 minutes as needed or start continuous infusion: 1 to 4 mcg/min.

Cardiac arrest: 0.5 to 1 mg bolus (1:10,000) q5min prn. May give 0.3 mg SC or start continuous infusion (range: 1 to 10 mcg/min).

Calculation of drip rate (ml/hr)
1 mg/250 ml: mcg/min x 15.

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Dosing (Adults):
Asystole:
I.V.: 1 mg every 3-5 minutes; if this approach fails, higher doses of epinephrine (up to 0.2 mg/kg) may be used, but are not recommended (Class Indeterminate; 2000 ACLS guidelines)

Intratracheal: Administer 2-2.5 times the recommended I.V. dose; dilute in 10 mL NS or distilled water. Note: Absorption is greater with distilled water, but causes more adverse effects on PaO2.

Bronchodilator: I.M., SubQ ( 1:1000 ): 0.1-0.5 mg every 10-15 minutes to 4 hours

Hypersensitivity reaction: I.M., SubQ: 0.3-0.5 mg every 15-20 minutes if condition requires; if hypotension is present: 0.1 mg I.V. slowly over 5-10 minutes followed by continuous infusion 1-10 mcg/minute

Symptomatic bradycardia or heart block (not responsive to atropine or pacing): I.V. infusion: 1-10 mcg/minute; titrate to desired effect

Refractory hypotension (refractory to dopamine/dobutamine): Continuous I.V. infusion 1 mcg/minute (range: 1-10 mcg/minute); titrate dosage to desired effect; severe cardiac dysfunction may require doses >10 mcg/minute (up to 0.1 mcg/kg/minute)

Nebulization: Instill 8-15 drops into nebulizer reservoirs; administer 1-3 inhalations 4-6 times/day

Administration
Central line administration only; intravenous infusions require an infusion pump

Epinephrine can be administered SubQ, I.M., I.V., or intracardiac injection

I.M. administration into the buttocks should be avoided

Preparation of adult I.V. infusion: Dilute 1 mg in 250 mL of D5W or NS (4 mcg/mL); administer at an initial rate of 1 mcg/minute and increase to desired effects; at 20 mcg/minute pure alpha effects occur

Extravasation management: Use phentolamine as antidote. Mix 5 mg with 9 mL of NS. Inject a small amount of this dilution into extravasated area. Blanching should reverse immediately. Monitor site. If blanching should recur, additional injections of phentolamine may be needed.

Stability
Epinephrine is sensitive to light and air; protection from light is recommended.

Oxidation turns drug pink, then a brown color; solutions should not be used if they are discolored or contain a precipitate.

Stability of injection of parenteral admixture at room temperature (25°C) or refrigeration (4°C): 24 hours.

Standard diluent: 1 mg/250 mL NS.

Source: [package insert]