- To provide rapid relief of anaphylaxis and hypersensitivity reactions.
- To restore cardiac rhythm in cardiac arrest.
- To provide circulatory support
- Hyperkalemia during a code transfusion (massive hemorrhage)
- Stable at room temperature. Protect from light
- Solution should not be used if brown in colour or contains precipitate
EPINEPHrine 6 mcg/mL:
- Draw up 0.3 mg (0.3 mL) of epinephrine 1 mg/mL (1:1000) and add to 49.7 mL of NS
EPINEPHrine 25 mcg/mL
- Draw up 1.25 mg (1.25 mL) of epinephrine 1 mg/mL (1:1000) and add to 48.75 mL of NS
EPINEPHrine 50 mcg/mL (central line only):
- Draw up 2.5 mg (2.5 mL) of epinephrine 1 mg/mL (1:1000) and add to 47.5 mL of NS
EPINEPHrine 200 mcg/mL (central line only):
- Draw up 10 mg (10 mL) of epinephrine 1 mg/mL (1:1000) and add to 40 mL of NS
- Solutions Compatible: dextrose up to D10W, 0.9% NaCl, dextrose-saline combinations, ringer's solution, ringer's lactate
- Additives/Above Cassette Compatible: no information
- Y-site Compatible: amino acids/dextrose, dobutamine, dopamine, morphine, pancuronium, KCl (up to 40 mmol/L), SMOF lipid 20%, - Incompatible: alkaline solutions (sodium bicarbonate),
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| IM |
YES. FOR ANAPHYLAXIS Note: 1 mg/mL = 1:1000 |
| IV Direct/Intraosseous |
YES. FOR PALS NOT for anaphylaxis Note: 0.1 mg/mL = 1:10,000 |
| IV Continuous Infusion |
YES |
Click here to access SDC Drug Infusion Sheet
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- ANAPHYLAXIS:
- 0.01 mg/kg/dose IM = 0.01 mL/kg/dose of 1 mg/mL (1:1000) Q 5 minutes PRN x 3 doses (Max: 0.5 mg/dose)
- IM Epi-Pen:
<30 kg: 0.15 mg
>30 kg: 0.30 mg - Patient can use their own supply of Epi-Pen while admitted - keep the supply at patient's bedside
- RESUSCITATION (PALS):
- 0.01 mg/kg/dose = 0.1 mL/kg/dose of 0.1 mg/mL (1:10,000) IV/IO Q 3-5 minutes PRN
- CONTINUOUS IV INFUSION
- 0.01-1 microgram/kg/minute
- Hyperkalemia during a code transfusion (massive hemorrhage)
-
Epinephrine as a bolus or infusion may be ordered by ANAESTHESIA for its potassium shifting effects and/or hemodynamic effects. Dosing is variable and dependent on clinical scenario
-
Bolus Epinephrine 0.001-0.01 mg/kg/dose IV (0.01- 0.1ml/kg/dose) of 0.1 mg/ml (1:10,000). Max dose 1 mg or 10 ml
-
Epinephrine infusion 0.05-0.5 mcg/kg/min, titrate to effect
-
-
In the OR setting, ANESTHESIA may also administer 1-10 mcg/kg/dose of 1 mg/ml (1:1000) epinephrine bolus, maximum dose 1 mg
-
- Most common (transient): fever, anxiety, tenseness, restlessness, throbbing headache, tremor, weakness, dizziness, pallor, respiratory difficulty
- Hypertension
- Peripheral constriction leading to pulmonary edema
- Repeated local injections can result in necrosis at sites of injection from vascular constriction
- Ventricular fibrillation
- If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.
- Monitor EKG, HR, BP, site of infusion for extravasation/excessive blanching
- Use with caution in patients with cardiovascular disease, hypertension, diabetes, hyperthyroidism
- Contraindicated in narrow angle glaucoma, shock, general anaesthesia with halogenated hydrocarbons, organic brain syndrome, labor, patients receiving MAO inhibitors
1 mg/mL = 1:1000
0.1 mg/mL = 1:10,000
DILUTED EPINEPHRINE 10 mcg/mL
FOR MINI BOLUS DOSING
- Diluted epinephrine may be indicated during a pre-arrest or hypotensive event
- Usual dosage: 5mcg (0.5mL) to 20mcg (2mL) IV PRN, as directed by the MD to maintain blood pressure
A 10 mL syringe of Diluted Epinephrine is made by adding 1 mL of Epinephrine 0. 1 mg/mL to 9mL of NaCL 0.9%.
| Epinephrine 0.1 mg/mL (1:10,000) | 1 mL |
| NaCL 0.9% | 9 mL |