How to Prepare 1:10,000 Epinephrine in ACLS
The 1:10,000 epinephrine solution (0.1 mg/mL) is commercially available pre-diluted and should NOT be prepared from scratch during cardiac arrest—use the pre-filled syringe directly. 1
Understanding Epinephrine Concentrations
Epinephrine comes in two standard concentrations that are critical to distinguish:
- 1:1,000 solution = 1 mg/mL (used for IM administration in anaphylaxis)
- 1:10,000 solution = 0.1 mg/mL (used for IV/IO administration in cardiac arrest)
The 1:10,000 concentration is supplied as 1 mg in 10 mL (0.1 mg/mL) in pre-filled syringes (ABBOJECT® Syringe). 1 This is the standard preparation used in ACLS protocols and requires no dilution.
ACLS Cardiac Arrest Dosing
For adult cardiac arrest, administer 1 mg (10 mL of the 1:10,000 solution) IV/IO every 3-5 minutes during resuscitation. 2, 3 Operationally, this means giving epinephrine every second cycle of CPR after the initial dose.
Key Administration Points:
- For shockable rhythms (VF/pVT): Give epinephrine after the third shock if initial defibrillation attempts fail 3
- For non-shockable rhythms (PEA/asystole): Give epinephrine as soon as vascular access is obtained 4
- Route priority: IV or IO access are equivalent; if neither is available, endotracheal administration at 10x the IV dose (0.1 mg/kg of 1:1,000 solution) may be used, though this is less effective 4
If Dilution is Absolutely Required
In the rare circumstance where only 1:1,000 epinephrine (1 mg/mL) is available and you must create 1:10,000:
Take 1 mL of 1:1,000 epinephrine (1 mg) and add 9 mL of normal saline to create 10 mL of 1:10,000 solution (0.1 mg/mL). 5
However, this should be avoided during active resuscitation due to time delays and potential dosing errors.
Critical Safety Considerations
Concentration confusion is a common and potentially fatal error. 5 The 1:1,000 solution is 10 times more concentrated than 1:10,000. Administering 10 mL of 1:1,000 IV instead of 1:10,000 would deliver 10 mg instead of 1 mg—a dangerous overdose.
Storage and Handling:
- Epinephrine is light-sensitive; protect from light until use 1
- Store at room temperature 20-25°C (68-77°F) 1
- Do not use if solution is colored, cloudy, or contains particulate matter 1
- Avoid extravasation—can cause severe tissue necrosis 5
Post-ROSC Epinephrine Use
After return of spontaneous circulation with persistent hypotension, switch to a continuous epinephrine infusion at 0.05-2 mcg/kg/min rather than repeated boluses. 6 To prepare this infusion: dilute 1 mg of epinephrine in 1,000 mL of 5% dextrose to produce a 1 mcg/mL solution, then titrate to achieve desired mean arterial pressure. 1
Special Populations
Pediatric dosing differs significantly: 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) with a maximum single dose of 1 mg, repeated every 3-5 minutes. 4 For neonates, the dose range is 0.01-0.03 mg/kg of 1:10,000 solution. 7
Anaphylaxis dosing also differs from cardiac arrest: use 0.2-0.5 mg (0.2-0.5 mL of 1:1,000 solution) IM, NOT the 1:10,000 dilution. 6 If IV epinephrine is required for anaphylactic shock with IV access, use 0.05-0.1 mg (0.5-1 mL of 1:10,000 solution) given slowly. 6