Parenteral Manual

EPINEPHrine HCl

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ADRENALIN
Classification: 
Sympathomimetic
Original Date: 
August 2005
Revised Date: 
February 2019
Indications: 
  • To provide rapid relief of anaphylaxis and hypersensitivity reactions.
  • To restore cardiac rhythm in cardiac arrest.
  • To provide circulatory support.
Reconstitution and Stability: 
  • Stable at room temperature. Protect from light and air
  • Solution should not be used if brown in colour or contains precipitate
Compatibility: 

- 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),

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IM

YES. FOR ANAPHYLAXIS
Dilution: 1 mg/mL

Note: 1 mg/mL = 1:1000

IV Direct/Intraosseous

YES. FOR PALS
Usual Dilution: 0.1 mg/mL
Infusion time: seconds

NOT for anaphylaxis

Note: 0.1 mg/mL = 1:10,000

IV Continuous Infusion

YES
Standard concentrations in ER/OR/PICU: 6 mcg/mL, 25 mcg/mL
                                                           Central line only: 50 mcg/mL, 200 mcg/mL

Click here to access SDC Drug Infusion Sheet

Dosage: 

(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
Potential hazards of parenteral administration: 
  • 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, click HERE for treatment guidelines.   
Notes: 
  • 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

                                 (0.01mg/mL, 1:100,000)

                                 FOR MINI BOLUS DOSING

  • Diluted epinephrine may be requested by physicians during resus cases.
  • It is sometimes referred to as an "Epi Spritzer".
  • It is a fast way to give small bolus doses (usually 1/10 – 1/20 of the usual PALS IV/IO dose).
  • The physician will use the 10 ml diluted epi syringe to administer small mini boluses  (eg 0.5 mL, 1 mL).

 

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

 

 

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.