Parenteral Manual


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): 
Original Date: 
August 2005
Revised Date: 
February 2019
  • 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

- 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.)


Dilution: 1 mg/mL

Note: 1 mg/mL = 1:1000

IV Direct/Intraosseous

Usual Dilution: 0.1 mg/mL
Infusion time: seconds

NOT for anaphylaxis

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

IV Continuous Infusion

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


(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • 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
  • 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


  • 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.   
  • 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



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