Epinephrin IV potency

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LYesther

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Hi.

In sever anaphylaxis there is a consideration for 0.1 epinephrine IV push.

as well know, epinephrine has very high potency.

Dose 1 mg of adrenaline IV can cause a serious side affect in a usually healty patient?

i'm preparing some debate about the easy judgment for Epi IV in anaphylaxis cases.

I will be gald to hear your opinion and experience.
 
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I give epi 1:10 for severe anaphylaxis refractory to other treatments. 1:1 is much too concentrated to give IV.
 
We give 0.3mg 1:10,000 IV.

Epinephrine has shown to reduce morbidity and mortality in anaphylactic shock patients. Early epi that is.
 
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We can give Epi 1:10 0.3mg IV for severe anaphylaxis or asthma where the patient is "near cardiac arrest".

Otherwise it is 1:1 0.3mg.

The 1:10 dose is very strong in itself so you never are going to want to give 1:1 IV which is 10x stronger. Even in a young healthy person there is going going to have detrimental effects. I'm not sure if that's the argument you are trying to make?
 
It's not really any stronger, just more concentrated.

I've given 1:1000 IV in arrests multiple times once I've used all my 1:10,000 pre-fills. I leave the line running and push it in the top port. By the time it hits their circulatory system it's diluted into the NSS that's running through the line.
 
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Robb said:
It's not really any stronger, just more concentrated.

I've given 1:1 IV in arrests multiple times once I've used all my 1:10 pre-fills. I leave the line running and push it in the top port. By the time it hits their circulatory system it's diluted into the NSS that's running through the line.
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It's really not 1:1 after doing all that and mixing it with the NS. If you were to push it like you would 1:10 it would have a higher potency. I understand it's the same medication, but 1:1 is going to have a greater more detrimental effect given IV. When 1:10 usually works just fine.
 
Anjel said:
It's really not 1:1 after doing all that and mixing it with the NS. If you were to push it like you would 1:10 it would have a higher potency. I understand it's the same medication, but 1:1 is going to have a greater more detrimental effect given IV. When 1:10 usually works just fine.
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Exactly. It's a lot easier than making 1:10,000.

Some places are moving towards an infusion of epi vs a bolus in anaphylaxis. Usually 1mg of 1:1,000 in 250mL of D5W started at 1mcg/minute and titrated to effect. I haven't heard of any EMS agencies doing it yet, only hospitals. I think it makes sense to give an IM injection and mix the drip while you let it work then start it if it's indicated.

There's a thread around here with a good discussion about this topic that had specific reasons as to why 1:1,000 IV is bad juju.

1:10,000 gives you greater dosing accuracy as well due to the greater volume.
 
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Your posts are very hard to understand.

0.1mg is a low dose for anaphylaxis. Most protocols I've seen are 0.3mg 1:10,000 IVP or 0.3-0.5 mg 1:1000 IM. That's adult dosing. Pediatrics are 0.01mg/kg 1:10,000 IVP or 1:1000 IM usually with a max of 0.3mg single dose.

What exactly are you asking? What are you trying to debate? The safety of IV epi?
 
To eliminate confusion, please use the correct concentrations.
Either 1:1,000 or 1:10,000.
Getting lazy with the notation is a bad habit.
 
1:1000 and 1:10,000 makes zero sense to me whatsoever.

1:1 to me means 1 mg in 1 mL and 1:10 would be 1 mg in 10 mL. Why the 1,000 and 10,000? I know it has to do with micrograms but every dosing guideline I've ever seen besides the drip is in milligrams.
 
How do you document epi in a code? How about epi in anaphylaxis? Or croup?

It makes good sense to be specific about the drug; "administered 1mg epi 1:10,000 via IO"
 
DEmedic said:
To eliminate confusion, please use the correct concentrations.
Either 1:1,000 or 1:10,000.
Getting lazy with the notation is a bad habit.
Click to expand...

I'm lazy when I'm typing on a phone :p Otherwise I usually try to use the correct terms.
 
Robb said:
1:1000 and 1:10,000 makes zero sense to me whatsoever.
Click to expand...

It's just a volume ratio. 1:1,000 means that out of 1,000 parts, 1 part is epi, and 1:10,000 means that out of 10,000 parts, 1 part is epi.

Why they label it like that rather than the standard "mg per ml" is beyond me. Even dumber is the volume percent that local anesthetics and some other drugs are labeled in. Everything should simply be labeled in mcg or mg per ml, IMO.
 
DEmedic said:
How do you document epi in a code? How about epi in anaphylaxis? Or croup?

It makes good sense to be specific about the drug; "administered 1mg epi 1:10,000 via IO"
Click to expand...

It's a flow chart so It'd be "Epinepherine 1:1000(0)" then "dose" then "units" then "route".
 
The local concentration of IV adrenaline for anaphylaxis, asthma, bradycardia and septic shock is either

a) boluses of 0.01 mg (10 ml of a solution made by adding 1 mg of adrenaline to 1,000 ml of 0.9% NaCl), or

b) an infusion as 1 mg adrenaline in 1,000 ml 0.9% NaCl run at 2 drops/second

I've never seen IV adrenaline used outside of cardiac arrest so can't attest to it personally but it's made explicitly clear in the new CPGs that it's only for patients who are peri-arrest; the rationale given is that IV adrenaline has the most risk of cardiotoxic side effects hence why it's reserved for people who are really unwell and given in the strongest dilution.
 
Clare said:
The local concentration of IV adrenaline for anaphylaxis, asthma, bradycardia and septic shock is either



a) boluses of 0.01 mg (10 ml of a solution made by adding 1 mg of adrenaline to 1,000 ml of 0.9% NaCl), or



b) an infusion as 1 mg adrenaline in 1,000 ml 0.9% NaCl run at 2 drops/second



I've never seen IV adrenaline used outside of cardiac arrest so can't attest to it personally but it's made explicitly clear in the new CPGs that it's only for patients who are peri-arrest; the rationale given is that IV adrenaline has the most risk of cardiotoxic side effects hence why it's reserved for people who are really unwell and given in the strongest dilution.
Click to expand...


Way off topic but Hi Clare!! :) Good to have you back around.
 
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